Healthcare Provider Details

I. General information

NPI: 1609793116
Provider Name (Legal Business Name): DR. NATHAN COLE DE JESUS PINEDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 MCHENRY AVE STE A3
MODESTO CA
95350-4352
US

IV. Provider business mailing address

1707 MCHENRY AVE STE A3
MODESTO CA
95350-4352
US

V. Phone/Fax

Practice location:
  • Phone: 209-578-1533
  • Fax:
Mailing address:
  • Phone: 209-281-1393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113339
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: