Healthcare Provider Details

I. General information

NPI: 1649304403
Provider Name (Legal Business Name): AMILCAR PINA M.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12021 WILMINGTON AVE BLDG 11
LOS ANGELES CA
90059-3019
US

IV. Provider business mailing address

17707 STUDEBAKER RD
CERRITOS CA
90703-2640
US

V. Phone/Fax

Practice location:
  • Phone: 424-296-3720
  • Fax:
Mailing address:
  • Phone: 562-402-0688
  • Fax: 562-402-3032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number68949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: