Provider Demographics
NPI:1912449315
Name:ANDINO, ERNESTO SR (SURGICAL ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:
Last Name:ANDINO
Suffix:SR
Gender:M
Credentials:SURGICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9482 NW 120TH ST APT 832
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4197
Mailing Address - Country:US
Mailing Address - Phone:786-246-7585
Mailing Address - Fax:
Practice Address - Street 1:9482 NW 120TH ST APT 832
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4197
Practice Address - Country:US
Practice Address - Phone:786-246-7585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13-665246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI13-665Medicaid
WI13-665Medicaid