Healthcare Provider Details

I. General information

NPI: 1265805147
Provider Name (Legal Business Name): RAFAEL PINEIRO APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 N KROME AVE STE 105
FLORIDA CITY FL
33034-2406
US

IV. Provider business mailing address

23438 SW 108TH AVE
HOMESTEAD FL
33032-6289
US

V. Phone/Fax

Practice location:
  • Phone: 786-556-8351
  • Fax: 786-504-2916
Mailing address:
  • Phone: 786-556-8351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN9292639
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9292639
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: