Healthcare Provider Details

I. General information

NPI: 1285946020
Provider Name (Legal Business Name): ORLANDO MORENO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 11/29/2020
Certification Date: 11/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 BISCAYNE BLVD STE 200
MIAMI FL
33132-1461
US

IV. Provider business mailing address

1764 SW 155TH PL
MIAMI FL
33185-4230
US

V. Phone/Fax

Practice location:
  • Phone: 786-652-2451
  • Fax:
Mailing address:
  • Phone: 786-343-6937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number332-PA
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number332-PA
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberNJDCATEMP-006339
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: