Healthcare Provider Details

I. General information

NPI: 1730833286
Provider Name (Legal Business Name): YADIRA A. MOSCOSO PHYSICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 02/03/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 SW 1ST STREET
MIAMI FL
33130
US

IV. Provider business mailing address

8925 SW 172ND AVE APT 1135
MIAMI FL
33196-3021
US

V. Phone/Fax

Practice location:
  • Phone: 786-461-1071
  • Fax:
Mailing address:
  • Phone: 786-487-1773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP4293
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: