Healthcare Provider Details

I. General information

NPI: 1780093872
Provider Name (Legal Business Name): ANDRES J PINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 09/12/2021
Certification Date: 09/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 FIVAY RD
HUDSON FL
34667-7103
US

IV. Provider business mailing address

PO BOX 336810
PONCE PR
00733-6810
US

V. Phone/Fax

Practice location:
  • Phone: 727-819-2929
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number32304-R
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number147952
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: