Healthcare Provider Details

I. General information

NPI: 1801820212
Provider Name (Legal Business Name): JOSE N MORENO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE BOX 016960 M851
MIAMI FL
33136-1005
US

IV. Provider business mailing address

7800 S.W. 87TH AVENUE SUITE C-340
MIAMI FL
33173-3570
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-4664
  • Fax: 305-243-8470
Mailing address:
  • Phone: 305-595-0109
  • Fax: 305-595-7092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME51429
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME51429
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: