Provider Demographics
NPI:1497994834
Name:PINO-CHALUJA, MARIANA
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:PINO-CHALUJA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 SW 73RD ST
Mailing Address - Street 2:CHILD DEVELOPMENT CENTER SUITE 100
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4679
Mailing Address - Country:US
Mailing Address - Phone:786-662-5080
Mailing Address - Fax:786-662-5081
Practice Address - Street 1:5975 SUNSET DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5166
Practice Address - Country:US
Practice Address - Phone:786-662-5080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1982688230OtherHOSPITAL
FL010058700Medicaid