Provider Demographics
NPI:1700573136
Name:PINERO, KELVIN JAMES III
Entity type:Individual
Prefix:
First Name:KELVIN
Middle Name:JAMES
Last Name:PINERO
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10500 SW 108TH AVE APT B406
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-8608
Mailing Address - Country:US
Mailing Address - Phone:954-829-7866
Mailing Address - Fax:
Practice Address - Street 1:6055 NW 104TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4867
Practice Address - Country:US
Practice Address - Phone:954-829-7866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23264895106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician