Provider Demographics
NPI:1215431010
Name:PINA, CARLOS LUIS (ARNP 9395534)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:LUIS
Last Name:PINA
Suffix:
Gender:M
Credentials:ARNP 9395534
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6255 W SUNSET BLVD FL 21
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7422
Mailing Address - Country:US
Mailing Address - Phone:323-860-5200
Mailing Address - Fax:323-467-7119
Practice Address - Street 1:750 SE 3RD AVE STE 100
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1153
Practice Address - Country:US
Practice Address - Phone:954-737-0273
Practice Address - Fax:954-761-2223
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9395534363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner