Healthcare Provider Details

I. General information

NPI: 1699360651
Provider Name (Legal Business Name): KAYLA RAE PINEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7428 W MILITARY DR STE D
SAN ANTONIO TX
78227-3010
US

IV. Provider business mailing address

7132 BANDERA RD UNIT 36
SAN ANTONIO TX
78238-1276
US

V. Phone/Fax

Practice location:
  • Phone: 210-673-8111
  • Fax:
Mailing address:
  • Phone: 830-275-0451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number352895
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: