Provider Demographics
NPI:1376356519
Name:PINOS HERNANDEZ, KATIE PAMELA
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:PAMELA
Last Name:PINOS HERNANDEZ
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 1:1875 PLAZA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2613
Mailing Address - Country:US
Mailing Address - Phone:612-800-1948
Mailing Address - Fax:651-389-9229
Practice Address - Street 1:1875 PLAZA DR STE 100
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2613
Practice Address - Country:US
Practice Address - Phone:612-800-1948
Practice Address - Fax:651-389-9229
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA762977400Medicaid