Healthcare Provider Details

I. General information

NPI: 1104563832
Provider Name (Legal Business Name): PIESCA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2022
Last Update Date: 05/14/2022
Certification Date: 05/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 BEACON ST APT 6
BOSTON MA
02115-1330
US

IV. Provider business mailing address

477 BEACON ST APT 6
BOSTON MA
02115-1330
US

V. Phone/Fax

Practice location:
  • Phone: 954-372-7536
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: PARKER KUIVILA
Title or Position: PRESIDENT
Credential: MD
Phone: 954-372-7536