Provider Demographics
NPI:1861123986
Name:PINERO, HEIKO AMPARO JR
Entity type:Individual
Prefix:
First Name:HEIKO
Middle Name:AMPARO
Last Name:PINERO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 MOUNTBURY CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-2545
Mailing Address - Country:US
Mailing Address - Phone:770-576-5906
Mailing Address - Fax:
Practice Address - Street 1:1275 MCCONNELL DR STE A
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3505
Practice Address - Country:US
Practice Address - Phone:770-576-5906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT014006225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty