MEDICARE: MIRIAM GUADALUPE PINEDA B.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	CG60365516	WA

General Provider Information

NPI Number	:	1528402716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM GUADALUPE PINEDA B.S.

Provider Business Mailing Address
First Line	:	901 N MONROE ST
Second Line	:	SUITE 200
City	:	SPOKANE
State	:	WA
Zip	:	99201-2104
Country	:	US
Telephone Number	:	509-302-7051
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 N MONROE ST
Second Line	:	SUITE 200
City	:	SPOKANE
State	:	WA
Zip	:	99201-2104
Country	:	US
Telephone Number	:	509-302-7051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2013
Last Update Date	:	04/18/2013

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