Provider Demographics
NPI:1871867309
Name:PINA, NANCY LISSET
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LISSET
Last Name:PINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3413
Mailing Address - Country:US
Mailing Address - Phone:323-953-7350
Mailing Address - Fax:
Practice Address - Street 1:3910 OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3413
Practice Address - Country:US
Practice Address - Phone:323-953-7350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker