Provider Demographics
NPI:1376575589
Name:PINERA, ANTONIO C (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:C
Last Name:PINERA
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 1:9930 SW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165
Mailing Address - Country:US
Mailing Address - Phone:305-226-6265
Mailing Address - Fax:305-226-0998
Practice Address - Street 1:9930 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165
Practice Address - Country:US
Practice Address - Phone:305-226-6265
Practice Address - Fax:305-226-0998
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0018369207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0501883-00Medicaid
D59591Medicare UPIN
FL0501883-00Medicaid