Provider Demographics
NPI:1265658744
Name:GIL-PINEDA, JESSIKA (MD)
Entity type:Individual
Prefix:DR
First Name:JESSIKA
Middle Name:
Last Name:GIL-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 1:1300 RED JOHN DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32124-1075
Mailing Address - Country:US
Mailing Address - Phone:386-254-1547
Mailing Address - Fax:386-947-1657
Practice Address - Street 1:1300 RED JOHN DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32124-1075
Practice Address - Country:US
Practice Address - Phone:386-254-1547
Practice Address - Fax:386-947-1657
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN391207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4188OtherAMERICAN HELTH MEDICARE
PR7030000OtherHUMANA REFORMA
PRI43975Medicare UPIN
PR0023489Medicare ID - Type UnspecifiedMEDICARE