Healthcare Provider Details

I. General information

NPI: 1144150236
Provider Name (Legal Business Name): NEPTALY MORENO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 W 36TH ST
HIALEAH FL
33012-5163
US

IV. Provider business mailing address

855 W 36TH ST
HIALEAH FL
33012-5163
US

V. Phone/Fax

Practice location:
  • Phone: 786-473-4069
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberBACB1565941
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: