Healthcare Provider Details

I. General information

NPI: 1275184855
Provider Name (Legal Business Name): PINE ISLAND MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7480 SW 40TH ST STE 430
MIAMI FL
33155-6630
US

IV. Provider business mailing address

7480 SW 40TH ST STE 430
MIAMI FL
33155-6630
US

V. Phone/Fax

Practice location:
  • Phone: 786-606-9387
  • Fax:
Mailing address:
  • Phone: 305-546-3849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: YAMIL JACOMINO
Title or Position: PRESIDENT
Credential:
Phone: 786-606-9387