Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | ME92834 | FL |
NPI | 1033306576 |
---|---|
Provider Name | Antonio Pino |
First Address | Miami, FL 33175-5256 |
Second Address | Miami, FL 33175-5256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2007 |
Last Update Date | 21/03/2011 |