Active NPI
Jaime Perez Pineda, CPO
- Orthotist
- Riverside, CA
National Provider Identifier
1417518358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthotist
- License
- 213000323
- Practice address
- 4244 Riverwalk Pkwy Ste 180
Riverside, CA 92505-8509 - Phone
- (951) 637-6586
- Fax
- (844) 447-5895
- NPI assigned
- Jun 21, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthotist | 222Z00000X | 213000323 | IL | Primary |
| Prosthetist | 224P00000X | 211000325 | IL |
Addresses
Primary practice location
4244 Riverwalk Pkwy Ste 180
Riverside, CA 92505-8509
Mailing address
4244 Riverwalk Pkwy Ste 180
Riverside, CA 92505-8509
Phone (951) 637-6586
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 213000323 | IL | MD | Orthotist |
| 211000325 | IL | MD | Prosthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1561075200000",
"number": "1417518358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4244 RIVERWALK PKWY STE 180",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925058509",
"telephone_number": "951-637-6586"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4244 RIVERWALK PKWY STE 180",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925058509",
"telephone_number": "951-637-6586",
"fax_number": "844-447-5895"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEREZ PINEDA",
"first_name": "JAIME",
"credential": "CPO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-06-21",
"last_updated": "2019-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "222Z00000X",
"taxonomy_group": "",
"desc": "Orthotist",
"state": "IL",
"license": "213000323",
"primary": true
},
{
"code": "224P00000X",
"taxonomy_group": "",
"desc": "Prosthetist",
"state": "IL",
"license": "211000325",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 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.