Healthcare Provider Details

I. General information

NPI: 1376575589
Provider Name (Legal Business Name): ANTONIO C PINERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9930 SW 40TH ST
MIAMI FL
33165
US

IV. Provider business mailing address

9930 SW 40TH ST
MIAMI FL
33165
US

V. Phone/Fax

Practice location:
  • Phone: 305-226-6265
  • Fax: 305-226-0998
Mailing address:
  • Phone: 305-226-6265
  • Fax: 305-226-0998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberME0018369
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: