Healthcare Provider Details

I. General information

NPI: 1487397972
Provider Name (Legal Business Name): MR. JULIAN DANIEL MOREYRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR FL 33328
DAVIE FL
33328-2018
US

IV. Provider business mailing address

1001 91ST ST APT 609
BAY HARBOR ISLANDS FL
33154-2795
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-1250
  • Fax:
Mailing address:
  • Phone: 786-262-2257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9118434
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: