Provider Demographics
NPI:1649223132
Name:PINIELLA, CARLOS JESUS (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:JESUS
Last Name:PINIELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CARLOS
Other - Middle Name:
Other - Last Name:PINIELLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PA
Mailing Address - Street 1:9275 SW 152 STREET
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157
Mailing Address - Country:US
Mailing Address - Phone:305-255-9577
Mailing Address - Fax:305-256-8633
Practice Address - Street 1:9275 SW 152 STREET
Practice Address - Street 2:SUITE 210
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157
Practice Address - Country:US
Practice Address - Phone:305-255-9577
Practice Address - Fax:305-256-8633
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062377207K00000X, 207KI0005X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003021OtherNEIGHBORHOOD HEALTH
FL373947300Medicaid
FL1669381003OtherWELLCARE
FL650511984OtherTAX ID
FL373947300Medicaid
FL1669381003OtherWELLCARE