Provider Demographics
NPI:1285227892
Name:HINESTROZA FINOL, DILMO ANTONIO (SA-C)
Entity Type:Individual
Prefix:
First Name:DILMO
Middle Name:ANTONIO
Last Name:HINESTROZA FINOL
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5457 BARBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-0339
Mailing Address - Country:US
Mailing Address - Phone:678-882-8121
Mailing Address - Fax:
Practice Address - Street 1:5457 BARBERRY AVE
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-0339
Practice Address - Country:US
Practice Address - Phone:678-882-8121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21-120246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant