Provider Demographics
NPI:1760702716
Name:DEMINO, ADAM HOWARD (PA-C)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:HOWARD
Last Name:DEMINO
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:29401 SW 125TH AVE BLDG 600
Mailing Address - Street 2:SPECIAL OPERATIONS COMMAND - SOUTH
Mailing Address - City:HOMESTEAD AFB
Mailing Address - State:FL
Mailing Address - Zip Code:33039-0001
Mailing Address - Country:US
Mailing Address - Phone:786-415-2054
Mailing Address - Fax:786-415-2976
Practice Address - Street 1:29401 SW 125TH AVE BLDG 600
Practice Address - Street 2:SPECIAL OPERATIONS COMMAND - SOUTH
Practice Address - City:HOMESTEAD AFB
Practice Address - State:FL
Practice Address - Zip Code:33039-0001
Practice Address - Country:US
Practice Address - Phone:786-415-2054
Practice Address - Fax:786-415-2976
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2015-03-02
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant