Basic Information
| Provider Information | |||||||||
| NPI: | 1760587950 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PINEDA | ||||||||
| FirstName: | ROSIE | ||||||||
| MiddleName: | BLAS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.S. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PINEDA | ||||||||
| OtherFirstName: | ROSIE | ||||||||
| OtherMiddleName: | BLAS | ||||||||
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| OtherCredential: | M.S. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 2196 | ||||||||
| Address2: | |||||||||
| City: | GLENDORA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917402196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269632856 | ||||||||
| FaxNumber: | 6269149416 | ||||||||
| Practice Location | |||||||||
| Address1: | 2990 INLAND EMPIRE BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099803427 | ||||||||
| FaxNumber: | 9099453426 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 11/24/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MFC 38716 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | MFC38716 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.