Healthcare Provider Details

I. General information

NPI: 1114856028
Provider Name (Legal Business Name): MR. JESUS MANUEL PINERO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14075 KEN AUSTIN PKWY
BROOKSVILLE FL
34613-4904
US

IV. Provider business mailing address

8001 BEATY GROVE DR
TAMPA FL
33626-1602
US

V. Phone/Fax

Practice location:
  • Phone: 352-797-7020
  • Fax:
Mailing address:
  • Phone: 813-926-5454
  • Fax: 813-920-9252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: