Healthcare Provider Details

I. General information

NPI: 1962762658
Provider Name (Legal Business Name): DIEGO ALEJANDRO PINZON PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5803 NW 151ST ST SUITE 101
MIAMI LAKES FL
33014-2473
US

IV. Provider business mailing address

5803 NW 151ST ST SUITE 101
MIAMI LAKES FL
33014-2473
US

V. Phone/Fax

Practice location:
  • Phone: 305-231-5266
  • Fax: 305-231-5264
Mailing address:
  • Phone: 305-231-5266
  • Fax: 305-231-5264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA23213
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: