Healthcare Provider Details

I. General information

NPI: 1780206003
Provider Name (Legal Business Name): PINEAPPLE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 E CITRUS AVE STE 201
REDLANDS CA
92373-4742
US

IV. Provider business mailing address

19 E CITRUS AVE STE 201
REDLANDS CA
92373-4742
US

V. Phone/Fax

Practice location:
  • Phone: 909-317-1309
  • Fax:
Mailing address:
  • Phone: 909-317-1309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANA VILLARREAL
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 909-317-1309