Provider Demographics
NPI:1235438391
Name:PINECREST MEDICAL GROUP
Entity Type:Organization
Organization Name:PINECREST MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:E
Authorized Official - Last Name:FARINAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:786-227-6867
Mailing Address - Street 1:15715 S DIXIE HWY STE 407
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1812
Mailing Address - Country:US
Mailing Address - Phone:786-227-6867
Mailing Address - Fax:786-227-6806
Practice Address - Street 1:15715 S DIXIE HWY STE 407
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-1812
Practice Address - Country:US
Practice Address - Phone:786-227-6867
Practice Address - Fax:786-227-6806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS3181207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty