Healthcare Provider Details

I. General information

NPI: 1104469972
Provider Name (Legal Business Name): GISELLE DELGADO MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W FLAGLER ST
MIAMI FL
33135-2120
US

IV. Provider business mailing address

860 NW 42ND AVE FL 5
MIAMI FL
33126-4172
US

V. Phone/Fax

Practice location:
  • Phone: 305-204-0333
  • Fax: 305-359-7546
Mailing address:
  • Phone: 305-204-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9112716
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: