Healthcare Provider Details

I. General information

NPI: 1396394615
Provider Name (Legal Business Name): EDUARDO ANDRES MOYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE FL 33136
MIAMI FL
33136-1005
US

IV. Provider business mailing address

325 S BISCAYNE BLVD APT 2217
MIAMI FL
33131-2462
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-8178
  • Fax: 305-585-5743
Mailing address:
  • Phone: 786-208-0996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME162088
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: