Provider Demographics
NPI:1922060011
Name:PINEDA, JULITA SE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULITA
Middle Name:SE
Last Name:PINEDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3456 W BANGS AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-3012
Mailing Address - Country:US
Mailing Address - Phone:732-922-1122
Mailing Address - Fax:732-922-1957
Practice Address - Street 1:3456 W BANGS AVE
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-3012
Practice Address - Country:US
Practice Address - Phone:732-922-1122
Practice Address - Fax:732-922-1957
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA076798207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP8621408OtherDEA NO.
077568Medicare ID - Type Unspecified
BP8621408OtherDEA NO.