Provider Demographics
NPI:1235929068
Name:PINEROS BAUTISTA, ANGELA SUSANA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:SUSANA
Last Name:PINEROS BAUTISTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 FRICK AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29404-2232
Mailing Address - Country:US
Mailing Address - Phone:843-818-8236
Mailing Address - Fax:
Practice Address - Street 1:1723 FRICK AVE UNIT B
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29404-2232
Practice Address - Country:US
Practice Address - Phone:843-818-8236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician