Healthcare Provider Details

I. General information

NPI: 1548461429
Provider Name (Legal Business Name): ALEJANDRO ERNESTO PINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11801 SW 90TH ST SUITE 201
MIAMI FL
33186-2182
US

IV. Provider business mailing address

PO BOX 198175
ATLANTA GA
30384-8175
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-1317
  • Fax: 305-279-6813
Mailing address:
  • Phone: 305-595-1317
  • Fax: 305-279-6813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberME122939
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: