Provider Demographics
NPI:1649726472
Name:PINA, IVETTE B
Entity type:Individual
Prefix:
First Name:IVETTE
Middle Name:B
Last Name:PINA
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 1:7780 SW 163RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-3448
Mailing Address - Country:US
Mailing Address - Phone:305-263-0370
Mailing Address - Fax:
Practice Address - Street 1:12030 SW 129TH CT STE 211
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4584
Practice Address - Country:US
Practice Address - Phone:305-639-8760
Practice Address - Fax:786-953-5144
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator