MEDICARE: PINES HEALTH CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1407408677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINES HEALTH CENTER INC

Provider Business Mailing Address
First Line	:	PO BOX 521044
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33152-1044
Country	:	US
Telephone Number	:	305-888-6959
Fax Number	:	305-887-8198

Provider Business Practice Location Address
First Line	:	7911 NW 72ND AVE STE 111
Second Line	:
City	:	MEDLEY
State	:	FL
Zip	:	33166-2221
Country	:	US
Telephone Number	:	305-888-6959
Fax Number	:	305-887-8198

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JAYNIER MOYA
Credential	:	MD
Telephone Number	:	305-776-5822

Provider Enumeration Date	:	07/09/2019
Last Update Date	:	08/08/2024

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