Healthcare Provider Details

I. General information

NPI: 1801000914
Provider Name (Legal Business Name): PABLO A CANINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9131 SW 8TH TER
MIAMI FL
33174-3155
US

IV. Provider business mailing address

2055 SW 8TH ST
MIAMI FL
33135-3357
US

V. Phone/Fax

Practice location:
  • Phone: 305-485-7299
  • Fax:
Mailing address:
  • Phone: 305-485-7299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME98585
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME98585
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: