Provider Demographics
NPI:1003094855
Name:PINO, LILIA DIAZ (PHD, ARNP)
Entity Type:Individual
Prefix:DR
First Name:LILIA
Middle Name:DIAZ
Last Name:PINO
Suffix:
Gender:F
Credentials:PHD, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 SW 100TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2523
Mailing Address - Country:US
Mailing Address - Phone:786-255-0763
Mailing Address - Fax:
Practice Address - Street 1:12955 SW 112TH ST
Practice Address - Street 2:MINUTECLINIC
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4768
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9182489363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAJ543ZMedicare PIN