Pineda Group LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

PINEDA GROUP LLC

Doing business as

Mystic Haven

Practice address

3421 Camsore Point LN
Las Vegas, NV 89129-6999

Phone

(702) 255-9171

Fax

(702) 202-3680

NPI assigned

May 13, 2019

Last updated

May 13, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Yannie Tablizo

Title

Managing Member

Phone

(702) 302-6932

Specialties & licenses 1

Addresses

Other names 1

• MYSTIC HAVEN Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557705600000",
    "number": "1205492568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4325 N TORREY PINES DR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891085510",
            "telephone_number": "702-658-5518",
            "fax_number": "702-202-3680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3421 CAMSORE POINT LN",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891296999",
            "telephone_number": "702-255-9171",
            "fax_number": "702-202-3680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINEDA GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-13",
        "last_updated": "2019-05-13",
        "status": "A",
        "authorized_official_last_name": "TABLIZO",
        "authorized_official_first_name": "YANNIE",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "702-302-6932"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MYSTIC HAVEN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Luseane Akolotu Pine
• Noribeth Valdez Pine
• Patricia Pine
• Tyler James Pine, DDS
• Jose Rafael Pineda Espinosa
• Wuendi Yadira Pineda Perez
• Rosa Pineda- Leon
• Maria Cecilia Pineda-Leon
• Valeria S Pineda-Rivera, MD
• Arianne Carisse Reyes Pineda, APRN-CNP

• Assisted Living Facility in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Assisted Living Facility in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.