Healthcare Provider Details

I. General information

NPI: 1427859859
Provider Name (Legal Business Name): BRIAN ALEXANDER MORENO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4675 PONCE DE LEON BLVD STE 201
CORAL GABLES FL
33146-2113
US

IV. Provider business mailing address

13870 SW 62ND ST APT 107
MIAMI FL
33183-2041
US

V. Phone/Fax

Practice location:
  • Phone: 305-669-6555
  • Fax: 305-669-6572
Mailing address:
  • Phone: 786-566-7529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS24200
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: