Provider Demographics
NPI:1174911473
Name:PINHEIRO, ANDREA SOPHIA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:SOPHIA
Last Name:PINHEIRO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SOPHIA
Other - Middle Name:
Other - Last Name:PINHEIRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15284 SW ROYALTY PKWY APT C01
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-3993
Mailing Address - Country:US
Mailing Address - Phone:305-713-4016
Mailing Address - Fax:
Practice Address - Street 1:7428 N CHARLESTON AVE APT 434
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-3782
Practice Address - Country:US
Practice Address - Phone:305-713-4016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA290011225800000X
OR20181225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Single Specialty