Healthcare Provider Details

I. General information

NPI: 1396376190
Provider Name (Legal Business Name): NCANCIOMORALESMDPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3661 S MIAMI AVE STE 402
MIAMI FL
33133-4230
US

IV. Provider business mailing address

3661 S MIAMI AVE STE 402
MIAMI FL
33133-4230
US

V. Phone/Fax

Practice location:
  • Phone: 305-281-7063
  • Fax: 347-493-4312
Mailing address:
  • Phone: 305-281-7063
  • Fax: 347-493-4312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278P1004X
TaxonomyPulmonary Diagnostics Certified Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. NESTOR CANCIO
Title or Position: DOCTOR
Credential:
Phone: 305-281-7063