MEDICARE: JACQUELINE MORENO

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	225700000X	Massage Therapist	MA93598	FL

General Provider Information

NPI Number	:	1740822881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE MORENO

Provider Business Mailing Address
First Line	:	11276 SW 90TH LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-1168
Country	:	US
Telephone Number	:	305-528-5256
Fax Number	:

Provider Business Practice Location Address
First Line	:	11276 SW 90TH LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-1168
Country	:	US
Telephone Number	:	305-528-5256
Fax Number	:

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

Provider Enumeration Date	:	10/10/2019
Last Update Date	:	10/10/2019

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Directions to “ JACQUELINE MORENO ” Practice Location

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