Healthcare Provider Details

I. General information

NPI: 1972132512
Provider Name (Legal Business Name): JOSE MIGUEL MORALES GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5361 NW 22ND AVE
MIAMI FL
33142-8035
US

IV. Provider business mailing address

2665 SW 37TH AVE APT 208
MIAMI FL
33133-2710
US

V. Phone/Fax

Practice location:
  • Phone: 305-637-6400
  • Fax: 305-636-5155
Mailing address:
  • Phone: 787-370-6861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME168478
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: