Provider Demographics
NPI:1558834044
Name:ALFONSO DEL PINO, JORGE ALBERTO
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:ALBERTO
Last Name:ALFONSO DEL PINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 HAIGHT AVE APT 4E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1424
Mailing Address - Country:US
Mailing Address - Phone:347-816-3236
Mailing Address - Fax:
Practice Address - Street 1:1803 HAIGHT AVE APT 4E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1424
Practice Address - Country:US
Practice Address - Phone:347-816-3236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care