Healthcare Provider Details

I. General information

NPI: 1376596205
Provider Name (Legal Business Name): ROBERTO ANDRES MOYA M.D., P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 W 68TH ST SUITE 201
HIALEAH FL
33016-1815
US

IV. Provider business mailing address

2140 W 68TH ST SUITE 201
HIALEAH FL
33016-1815
US

V. Phone/Fax

Practice location:
  • Phone: 305-826-4046
  • Fax: 305-556-6271
Mailing address:
  • Phone: 305-826-4046
  • Fax: 305-556-6271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME31217
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: