Healthcare Provider Details

I. General information

NPI: 1013854595
Provider Name (Legal Business Name): SAMANTHA PINEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18612 SANTA ANA AVE
BLOOMINGTON CA
92316-2639
US

IV. Provider business mailing address

18612 SANTA ANA AVE
BLOOMINGTON CA
92316-2639
US

V. Phone/Fax

Practice location:
  • Phone: 840-220-9529
  • Fax: 840-220-9529
Mailing address:
  • Phone: 840-220-9529
  • Fax: 840-220-9529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number734969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: