Provider Demographics
NPI:1225543762
Name:PINO PEREZ, GEORGE SR
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:PINO PEREZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 NW 79TH AVE APT 114
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6303
Mailing Address - Country:US
Mailing Address - Phone:786-624-1454
Mailing Address - Fax:
Practice Address - Street 1:2555 NW 102ND AVE STE 110
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-1301
Practice Address - Country:US
Practice Address - Phone:305-597-8707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician