Healthcare Provider Details

I. General information

NPI: 1508000696
Provider Name (Legal Business Name): HERNAN PINILLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2877 INLET COVE LN W
NAPLES FL
34120-7569
US

IV. Provider business mailing address

2877 INLET COVE LN W
NAPLES FL
34120-7569
US

V. Phone/Fax

Practice location:
  • Phone: 239-834-7343
  • Fax: 239-433-6706
Mailing address:
  • Phone: 239-834-7343
  • Fax: 239-433-6706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: