Healthcare Provider Details

I. General information

NPI: 1215431010
Provider Name (Legal Business Name): CARLOS LUIS PINA ARNP 9395534
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 SE 3RD AVE STE 100
FORT LAUDERDALE FL
33316-1153
US

IV. Provider business mailing address

6255 W SUNSET BLVD FL 21
LOS ANGELES CA
90028-7422
US

V. Phone/Fax

Practice location:
  • Phone: 954-737-0273
  • Fax: 954-761-2223
Mailing address:
  • Phone: 323-860-5200
  • Fax: 323-467-7119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9395534
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: