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General NPI Number Information
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NPI Number | 1275184855
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Entity Type | Organization
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Legal Business Name | PINE ISLAND MEDICAL INC
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Dates
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Enumeration Date | 09/24/2019
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 7480 SW 40TH ST STE 430
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City | MIAMI
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State | FL
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Zip | 33155-6630
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Country | US
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Telephone | 786-606-9387
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Fax |
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Provider Business Mailing Address
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Address Line | 7480 SW 40TH ST STE 430
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City | MIAMI
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State | FL
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Zip | 33155-6630
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Country | US
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Telephone | 305-546-3849
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YAMIL JACOMINO
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Credential |
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Telephone | 786-606-9387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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