Healthcare Provider Details

I. General information

NPI: 1396865333
Provider Name (Legal Business Name): HECTOR NARCISO PINEDA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2007
Last Update Date: 05/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15718 PARAMOUNT BLVD
PARAMOUNT CA
90723-4352
US

IV. Provider business mailing address

4207 SLAUSON AVE
MAYWOOD CA
90270-2835
US

V. Phone/Fax

Practice location:
  • Phone: 562-634-2111
  • Fax: 562-634-2112
Mailing address:
  • Phone: 323-560-1100
  • Fax: 323-560-1333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: