Healthcare Provider Details

I. General information

NPI: 1700875119
Provider Name (Legal Business Name): ISMAEL S MORERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 EAST 25TH ST STE 311
HIALEAH FL
33013
US

IV. Provider business mailing address

9737 NW 41ST ST #386
MIAMI FL
33178
US

V. Phone/Fax

Practice location:
  • Phone: 305-836-5627
  • Fax: 305-835-4453
Mailing address:
  • Phone: 305-836-5627
  • Fax: 305-835-4453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0060059
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: