Healthcare Provider Details

I. General information

NPI: 1669025052
Provider Name (Legal Business Name): LOREIN MOYA RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9655 NW 41ST ST
DORAL FL
33178-2973
US

IV. Provider business mailing address

900 S PINE ISLAND RD STE 800
PLANTATION FL
33324-3923
US

V. Phone/Fax

Practice location:
  • Phone: 305-436-1563
  • Fax: 305-436-1564
Mailing address:
  • Phone: 305-436-1563
  • Fax: 305-436-1564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME169874
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: