Healthcare Provider Details

I. General information

NPI: 1558208413
Provider Name (Legal Business Name): DIANA ELENA CEDRON MOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 W 49TH PL
HIALEAH FL
33012-3113
US

IV. Provider business mailing address

26170 SW 132ND PL
HOMESTEAD FL
33032-6849
US

V. Phone/Fax

Practice location:
  • Phone: 305-558-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberNOTAPPLICABLE
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: