Provider Demographics
NPI:1922860899
Name:PINO LUEZA, RAMON
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:
Last Name:PINO LUEZA
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 1:306 E BUTLER RD STE B
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-3251
Mailing Address - Country:US
Mailing Address - Phone:864-558-5777
Mailing Address - Fax:
Practice Address - Street 1:306 E BUTLER RD STE B
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-3251
Practice Address - Country:US
Practice Address - Phone:864-558-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor