Healthcare Provider Details

I. General information

NPI: 1902726698
Provider Name (Legal Business Name): HEIDI PINO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15640 N 7TH ST
PHOENIX AZ
85022-3512
US

IV. Provider business mailing address

12061 N 53RD AVE
GLENDALE AZ
85304-2708
US

V. Phone/Fax

Practice location:
  • Phone: 623-288-4051
  • Fax:
Mailing address:
  • Phone: 602-448-3955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: HEIDI PINO
Title or Position: OWNER
Credential:
Phone: 602-448-3955