Healthcare Provider Details

I. General information

NPI: 1760954945
Provider Name (Legal Business Name): MOREIRA MEDICAL GROUP, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2018
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1671 W 37TH ST STE 3
HIALEAH FL
33012-4639
US

IV. Provider business mailing address

1671 W 37TH ST STE 3
HIALEAH FL
33012-4639
US

V. Phone/Fax

Practice location:
  • Phone: 786-515-3156
  • Fax:
Mailing address:
  • Phone: 786-515-3156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MASIEL MOREIRA
Title or Position: CEO
Credential:
Phone: 786-515-3156