Provider Demographics
NPI:1477666477
Name:DEL PINO, VIRGILIO (MD)
Entity type:Individual
Prefix:DR
First Name:VIRGILIO
Middle Name:
Last Name:DEL PINO
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 1:4240 SW 143RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6811
Mailing Address - Country:US
Mailing Address - Phone:786-235-1031
Mailing Address - Fax:786-235-1033
Practice Address - Street 1:351 NW 42ND AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5683
Practice Address - Country:US
Practice Address - Phone:786-235-1031
Practice Address - Fax:786-235-1033
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267085200Medicaid
FLU1042Medicare ID - Type UnspecifiedFL MEDICARE
FL267085200Medicaid