Healthcare Provider Details

I. General information

NPI: 1194055335
Provider Name (Legal Business Name): MYRTHA MOISE RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2010
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

688 NW 101ST ST
MIAMI FL
33150-1421
US

IV. Provider business mailing address

688 NW 101ST ST
MIAMI FL
33150-1421
US

V. Phone/Fax

Practice location:
  • Phone: 305-759-0072
  • Fax: 954-404-6053
Mailing address:
  • Phone: 305-759-0072
  • Fax: 954-404-6053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279H0200X
TaxonomyHome Health Registered Respiratory Therapist
License NumberRT10401
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: