Provider Demographics
NPI:1821018789
Name:PINEDA, JESUS SERGIO (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:SERGIO
Last Name:PINEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7210 MCPHERSON RD
Mailing Address - Street 2:220
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6507
Mailing Address - Country:US
Mailing Address - Phone:956-727-0849
Mailing Address - Fax:956-712-2814
Practice Address - Street 1:7210 MCPHERSON RD
Practice Address - Street 2:STE 220
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6507
Practice Address - Country:US
Practice Address - Phone:956-727-0849
Practice Address - Fax:956-712-2814
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7419207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U03COtherBC/BS
TX135390604Medicaid
TX135390609Medicaid
TX00U03COtherBC/BS
TX135390609Medicaid