Healthcare Provider Details

I. General information

NPI: 1225663172
Provider Name (Legal Business Name): RICARDO PINEIRO HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20215 NW 2ND AVE STE 1
MIAMI FL
33169-2538
US

IV. Provider business mailing address

5200 NE 2ND AVE
MIAMI FL
33137-2706
US

V. Phone/Fax

Practice location:
  • Phone: 305-685-5688
  • Fax:
Mailing address:
  • Phone: 305-751-8626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11006031
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: