Healthcare Provider Details

I. General information

NPI: 1689109738
Provider Name (Legal Business Name): ROBERTO ANDINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2733 PONCE DE LEON BLVD
CORAL GABLES FL
33134-6004
US

IV. Provider business mailing address

2733 PONCE DE LEON BLVD
CORAL GABLES FL
33134-6004
US

V. Phone/Fax

Practice location:
  • Phone: 305-444-6749
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME141576
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME141576
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME141576
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: