Healthcare Provider Details

I. General information

NPI: 1700600368
Provider Name (Legal Business Name): MONICA PINEDA LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15351 W BELL RD
SURPRISE AZ
85374-4580
US

IV. Provider business mailing address

8222 S 48TH ST STE 200
PHOENIX AZ
85044-5303
US

V. Phone/Fax

Practice location:
  • Phone: 480-964-2273
  • Fax:
Mailing address:
  • Phone: 623-300-5477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC22901
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: