MEDICARE: FERNANDO PINO RIVERA DDS

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223P0700X	Prosthodontics	DN24271	FL
3	1223G0001X	General Practice Dentistry	DN24271	FL

General Provider Information

NPI Number	:	1922414457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERNANDO PINO RIVERA DDS

Provider Business Mailing Address
First Line	:	8811 SW 123RD CT APT 102
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-1957
Country	:	US
Telephone Number	:	305-588-7545
Fax Number	:

Provider Business Practice Location Address
First Line	:	7036 CORAL WAY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-1603
Country	:	US
Telephone Number	:	786-673-3555
Fax Number	:

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

Provider Enumeration Date	:	07/03/2014
Last Update Date	:	05/16/2023

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