Provider Demographics
NPI:1285923896
Name:FERNANDO PINO M.D.P.A.
Entity type:Organization
Organization Name:FERNANDO PINO M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PA
Authorized Official - Phone:305-595-1949
Mailing Address - Street 1:8600 SW 92ND STREET
Mailing Address - Street 2:SUITE # 104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7377
Mailing Address - Country:US
Mailing Address - Phone:305-595-1949
Mailing Address - Fax:305-595-6455
Practice Address - Street 1:8600 SW 92ND STREET
Practice Address - Street 2:SUITE # 104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7377
Practice Address - Country:US
Practice Address - Phone:305-595-1949
Practice Address - Fax:305-595-6455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52016273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371123400Medicaid
D61148Medicare UPIN