Healthcare Provider Details

I. General information

NPI: 1346165719
Provider Name (Legal Business Name): MIREYA EULALIA PINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 CALLE CESAR E CHAVEZ
GUADALUPE CA
93434-1836
US

IV. Provider business mailing address

118 NARLENE WAY
PISMO BEACH CA
93449-3204
US

V. Phone/Fax

Practice location:
  • Phone: 805-842-5148
  • Fax:
Mailing address:
  • Phone: 760-616-4007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: