Provider Demographics
NPI:1205492568
Name:PINEDA GROUP LLC
Entity type:Organization
Organization Name:PINEDA GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:YANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TABLIZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-302-6932
Mailing Address - Street 1:4325 N TORREY PINES DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-5510
Mailing Address - Country:US
Mailing Address - Phone:702-658-5518
Mailing Address - Fax:702-202-3680
Practice Address - Street 1:3421 CAMSORE POINT LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-6999
Practice Address - Country:US
Practice Address - Phone:702-255-9171
Practice Address - Fax:702-202-3680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility