Provider Demographics
NPI:1326394768
Name:PINO, JOSEPH SEBASTIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:SEBASTIAN
Last Name:PINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E LAS OLAS BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2357
Mailing Address - Country:US
Mailing Address - Phone:954-463-4321
Mailing Address - Fax:954-453-5497
Practice Address - Street 1:1601 E LAS OLAS BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2357
Practice Address - Country:US
Practice Address - Phone:954-463-4321
Practice Address - Fax:954-453-5497
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1277302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYFR0435669174OtherHOSPITAL DEA NUMBER