Healthcare Provider Details

I. General information

NPI: 1477880821
Provider Name (Legal Business Name): WILBERT B PINO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 LAKE WORTH RD SUITE 103
GREENACRES FL
33463-4727
US

IV. Provider business mailing address

PO BOX 212487
ROYAL PALM BEACH FL
33421-2487
US

V. Phone/Fax

Practice location:
  • Phone: 561-296-2345
  • Fax: 561-296-2346
Mailing address:
  • Phone: 561-296-2345
  • Fax: 561-296-2346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SIMON ASHI
Title or Position: PRACTICE MANAGER
Credential: M.D.
Phone: 561-317-2877