Healthcare Provider Details

I. General information

NPI: 1235300211
Provider Name (Legal Business Name): NICOLAS IVAN PINEIRO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 N FLAGLER DR
WEST PALM BEACH FL
33401-3406
US

IV. Provider business mailing address

1309 N FLAGLER DR
WEST PALM BEACH FL
33401-3406
US

V. Phone/Fax

Practice location:
  • Phone: 561-882-4541
  • Fax: 561-650-6093
Mailing address:
  • Phone: 561-882-4541
  • Fax: 561-650-6093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME100401
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL2726R
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME100401
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: