Healthcare Provider Details

I. General information

NPI: 1164137055
Provider Name (Legal Business Name): FERNANDO PACHECO PINEYRO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5890 NW 173RD DR
HIALEAH FL
33015-5103
US

IV. Provider business mailing address

20725 SW 81ST CT
CUTLER BAY FL
33189-3430
US

V. Phone/Fax

Practice location:
  • Phone: 305-708-5555
  • Fax: 786-652-1642
Mailing address:
  • Phone: 786-720-1109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11023845
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: