MEDICARE: CARLOS PINO

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	133V00000X	Registered Dietitian	9717	FL
2	133V00000X	Registered Dietitian	2814	SC

General Provider Information

NPI Number	:	1659180743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS PINO

Provider Business Mailing Address
First Line	:	1133 HARTS RIDGE DR
Second Line	:
City	:	SENECA
State	:	SC
Zip	:	29678-1478
Country	:	US
Telephone Number	:	904-885-7113
Fax Number	:

Provider Business Practice Location Address
First Line	:	1133 HARTS RIDGE DR
Second Line	:
City	:	SENECA
State	:	SC
Zip	:	29678-1478
Country	:	US
Telephone Number	:	904-885-7113
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2025
Last Update Date	:	01/02/2025

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Directions to “ CARLOS PINO ” Practice Location

Language	Start Address	Practice Location

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