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NPI Code Detail

MEDICARE: EDNA DE PINA

MEDICARE: EDNA DE PINA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1417137373
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDNA DE PINA
Provider Business Mailing Address
First Line : 1800 COLUMBUS AVE
Second Line :
City : ROXBURY
State : MA
Zip : 02119-1042
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1800 COLUMBUS AVE
Second Line :
City : ROXBURY
State : MA
Zip : 02119-1042
Country : US
Telephone Number : 617-442-8800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2007
Last Update Date : 11/08/2007

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Directions to “ EDNA DE PINA ” Practice Location

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