Basic Information
| Provider Information | |||||||||
| NPI: | 1154847648 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PINEDA | ||||||||
| FirstName: | EDGAR | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | JR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2620 INDUSTRY WAY | ||||||||
| Address2: | |||||||||
| City: | LYNWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902624024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106674070 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2046 ALLEN AVE # 100 | ||||||||
| Address2: | |||||||||
| City: | ALTADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263965920 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2017 | ||||||||
| LastUpdateDate: | 07/06/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | ASW83280 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.