Provider Demographics
NPI:1386402980
Name:PINO ALFONSO, YADIER
Entity type:Individual
Prefix:
First Name:YADIER
Middle Name:
Last Name:PINO ALFONSO
Suffix:
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 1:14490 SW 160TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-1700
Mailing Address - Country:US
Mailing Address - Phone:786-826-7440
Mailing Address - Fax:
Practice Address - Street 1:14490 SW 160TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1700
Practice Address - Country:US
Practice Address - Phone:786-826-7440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician