Provider Demographics
NPI:1902247026
Name:PIRE, ROBERTO ANDRES (SUPPORT COORDINATOR)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:ANDRES
Last Name:PIRE
Suffix:
Gender:M
Credentials:SUPPORT COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6267 W 24TH AVE
Mailing Address - Street 2:APT 104
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6956
Mailing Address - Country:US
Mailing Address - Phone:305-351-6133
Mailing Address - Fax:
Practice Address - Street 1:6267 W 24TH AVE
Practice Address - Street 2:APT 104
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-6956
Practice Address - Country:US
Practice Address - Phone:305-351-6133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL691667801171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL691667801Medicaid