Healthcare Provider Details

I. General information

NPI: 1033159835
Provider Name (Legal Business Name): RENE ANDINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3416 W 84TH ST SUITE 100
HIALEAH FL
33018-4923
US

IV. Provider business mailing address

3416 W 84TH ST STE 100
HIALEAH GARDENS FL
33018-4934
US

V. Phone/Fax

Practice location:
  • Phone: 305-826-9449
  • Fax: 305-828-1255
Mailing address:
  • Phone: 305-826-9449
  • Fax: 305-828-1255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberME66384
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME66384
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: