Healthcare Provider Details

I. General information

NPI: 1912574351
Provider Name (Legal Business Name): STEPHANIE PINEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 MICA DR STE 13
CARSON CITY NV
89705-7181
US

IV. Provider business mailing address

2170 SOUTH AVE
SOUTH LAKE TAHOE CA
96150-7026
US

V. Phone/Fax

Practice location:
  • Phone: 775-783-3065
  • Fax: 775-267-1829
Mailing address:
  • Phone: 530-541-3420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2690
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: