Provider Demographics
NPI:1386918738
Name:DEL PINO FLORES, ROBERTO (MT)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:DEL PINO FLORES
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8524 SW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3214
Mailing Address - Country:US
Mailing Address - Phone:305-207-9510
Mailing Address - Fax:305-207-9511
Practice Address - Street 1:8524 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3214
Practice Address - Country:US
Practice Address - Phone:305-207-9510
Practice Address - Fax:305-207-9511
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA62175225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist