Healthcare Provider Details

I. General information

NPI: 1922442458
Provider Name (Legal Business Name): CATHERINE ANDREA MOYA KRUMENACKER M.D, PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 NW 1ST ST
FORT LAUDERDALE FL
33311-8905
US

IV. Provider business mailing address

1700 NW 49TH ST STE 125
FORT LAUDERDALE FL
33309-3750
US

V. Phone/Fax

Practice location:
  • Phone: 954-761-1020
  • Fax: 954-761-9983
Mailing address:
  • Phone: 954-761-1020
  • Fax: 954-761-9983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number89609
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01076704A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME168015
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: