Provider Demographics
NPI:1902871825
Name:PINERO PREVENTIVE MEDICAL CARE PA
Entity Type:Organization
Organization Name:PINERO PREVENTIVE MEDICAL CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:DUNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-426-9693
Mailing Address - Street 1:2766 E. COLONIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5025
Mailing Address - Country:US
Mailing Address - Phone:407-426-9693
Mailing Address - Fax:407-426-9694
Practice Address - Street 1:2766 E. COLONIAL DRIVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5025
Practice Address - Country:US
Practice Address - Phone:407-426-9693
Practice Address - Fax:407-426-9694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty