Provider Demographics
NPI:1255483905
Name:CARLOS PINIELLA MD PA
Entity Type:Organization
Organization Name:CARLOS PINIELLA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:JESUS
Authorized Official - Last Name:PINIELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-666-0726
Mailing Address - Street 1:6705 SW 57TH AVE STE 520
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3649
Mailing Address - Country:US
Mailing Address - Phone:305-666-0726
Mailing Address - Fax:305-666-0792
Practice Address - Street 1:9275 SW 152ND STREET
Practice Address - Street 2:SUITE 210
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1774
Practice Address - Country:US
Practice Address - Phone:305-255-9577
Practice Address - Fax:305-255-3115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062377207K00000X
207KA0200X, 207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
No207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1669381003OtherCIGNA
FL373947300Medicaid
FL3739473-01Medicaid
FL4519317OtherAETNA
FL3739473-03Medicaid
FL373947300Medicaid
FL4519317OtherAETNA
FL23125Medicare PIN