Provider Demographics
NPI:1962762658
Name:PINZON, DIEGO ALEJANDRO (PTA)
Entity type:Individual
Prefix:MR
First Name:DIEGO
Middle Name:ALEJANDRO
Last Name:PINZON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5803 NW 151ST ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2473
Mailing Address - Country:US
Mailing Address - Phone:305-231-5266
Mailing Address - Fax:305-231-5264
Practice Address - Street 1:5803 NW 151ST ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2473
Practice Address - Country:US
Practice Address - Phone:305-231-5266
Practice Address - Fax:305-231-5264
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA23213225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant