Healthcare Provider Details

I. General information

NPI: 1619479987
Provider Name (Legal Business Name): JUSTIN PINEDA CARLOS BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 UNIVERSITY AVE STE 200
SACRAMENTO CA
95825-6540
US

IV. Provider business mailing address

7108 S KANNER HWY
STUART FL
34997-7462
US

V. Phone/Fax

Practice location:
  • Phone: 916-895-0695
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-32939
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: