Provider Demographics
NPI:1942913140
Name:PINEDA, LAURA SOFIA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:SOFIA
Last Name:PINEDA
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 1:6471 MAIN ST APT 106
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2254
Mailing Address - Country:US
Mailing Address - Phone:786-306-0741
Mailing Address - Fax:
Practice Address - Street 1:7925 NW 12TH ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1827
Practice Address - Country:US
Practice Address - Phone:786-870-5090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician