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General NPI Number Information
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NPI Number | 1104528512
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Entity Type | Individual
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Provider Name | JENNIFER PINEDA
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Gender | Female
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 12021 WILMINGTON AVE BLDG 18
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City | LOS ANGELES
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State | CA
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Zip | 90059-3019
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Country | US
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Telephone | 424-454-5530
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Fax |
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Provider Business Mailing Address
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Address Line | 1832 W COMMONWEALTH AVE UNIT 109
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City | FULLERTON
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State | CA
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Zip | 92833-3048
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Country | US
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Telephone | 714-583-2806
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 167G00000X
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Taxonomy Name | Licensed Psychiatric Technician
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License Number | 42839
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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