MEDICARE: ROSA I. MORENO BS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1417275991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSA I. MORENO BS

Provider Business Mailing Address
First Line	:	11031 NE 6TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33161-7182
Country	:	US
Telephone Number	:	305-398-6100
Fax Number	:	305-757-4465

Provider Business Practice Location Address
First Line	:	1566 SW 1ST ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135-2103
Country	:	US
Telephone Number	:	305-642-8325
Fax Number	:	305-643-7713

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2010
Last Update Date	:	05/10/2010

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Directions to “ ROSA I. MORENO BS” Practice Location

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