Healthcare Provider Details

I. General information

NPI: 1811716632
Provider Name (Legal Business Name): MR. NICOLAS ANGEL CHIRINO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/08/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 S UNIVERSITY DR SUIT 203
DAVIE FL
33328
US

IV. Provider business mailing address

15834 SW 52ND ST
MIRAMAR FL
33027
US

V. Phone/Fax

Practice location:
  • Phone: 954-513-9545
  • Fax:
Mailing address:
  • Phone: 305-975-6128
  • Fax:

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: