Healthcare Provider Details

I. General information

NPI: 1588650204
Provider Name (Legal Business Name): CARLOS MANUEL MOAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 02/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3661 S MIAMI AVE SUITE 1008
MIAMI FL
33133-4236
US

IV. Provider business mailing address

15680 N KENDALL DR SUITE 201
MIAMI FL
33196-1159
US

V. Phone/Fax

Practice location:
  • Phone: 305-854-2284
  • Fax: 305-851-7963
Mailing address:
  • Phone: 305-436-9933
  • Fax: 305-436-9944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME42965
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: