Healthcare Provider Details

I. General information

NPI: 1326488826
Provider Name (Legal Business Name): LEYDIS MORONO M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 SW 107TH AVE
MIAMI FL
33165-7344
US

IV. Provider business mailing address

1621 SW 107TH AVE
MIAMI FL
33165-7344
US

V. Phone/Fax

Practice location:
  • Phone: 786-422-6525
  • Fax: 786-621-7815
Mailing address:
  • Phone: 786-422-6525
  • Fax: 786-621-7815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME128381
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: