Healthcare Provider Details

I. General information

NPI: 1164804787
Provider Name (Legal Business Name): KEILA N DIAZ MORALES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 CELEBRATION PL STE 302
CELEBRATION FL
34747-5435
US

IV. Provider business mailing address

410 CELEBRATION PL STE 302
CELEBRATION FL
34747-5435
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-3824
  • Fax: 407-303-3825
Mailing address:
  • Phone: 407-303-3824
  • Fax: 407-303-3825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME145642
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: