Healthcare Provider Details

I. General information

NPI: 1952678278
Provider Name (Legal Business Name): JOSE MOYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1084 NW 135TH CT
MIAMI FL
33182-2616
US

IV. Provider business mailing address

1084 NW 135TH CT
MIAMI FL
33182-2616
US

V. Phone/Fax

Practice location:
  • Phone: 786-564-4249
  • Fax:
Mailing address:
  • Phone: 786-564-4249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberCM17354
License Number StateZZ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMSAS 43258
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: