Healthcare Provider Details

I. General information

NPI: 1134501067
Provider Name (Legal Business Name): YUNIET MOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2015
Last Update Date: 06/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

946 NE 42ND TER
HOMESTEAD FL
33033-6615
US

IV. Provider business mailing address

946 NE 42ND TER
HOMESTEAD FL
33033-6615
US

V. Phone/Fax

Practice location:
  • Phone: 305-812-1618
  • Fax:
Mailing address:
  • Phone: 305-812-1618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31772 R
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: