Provider Demographics
NPI:1760813299
Name:PINEDA, JORGE
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:PINEDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND PONTEZUELA EDIF B-1 APT D-1
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-2054
Mailing Address - Country:US
Mailing Address - Phone:787-547-4017
Mailing Address - Fax:
Practice Address - Street 1:COND PONTEZUELA
Practice Address - Street 2:EDIF B-1 APT D-1
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-2054
Practice Address - Country:US
Practice Address - Phone:787-547-4017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6923183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician