Healthcare Provider Details

I. General information

NPI: 1902871825
Provider Name (Legal Business Name): PINERO PREVENTIVE MEDICAL CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 09/26/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2766 E. COLONIAL DRIVE
ORLANDO FL
32803-5025
US

IV. Provider business mailing address

2766 E. COLONIAL DRIVE
ORLANDO FL
32803-5025
US

V. Phone/Fax

Practice location:
  • Phone: 407-426-9693
  • Fax: 407-426-9694
Mailing address:
  • Phone: 407-426-9693
  • Fax: 407-426-9694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS WAYNE DUNHAM
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 407-426-9693