Healthcare Provider Details

I. General information

NPI: 1619881109
Provider Name (Legal Business Name): RONALD MORALES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13444 SW 91ST TER
MIAMI FL
33186-1519
US

IV. Provider business mailing address

13444 SW 91ST TER
MIAMI FL
33186-1519
US

V. Phone/Fax

Practice location:
  • Phone: 786-683-3877
  • Fax:
Mailing address:
  • Phone: 786-683-3877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11051032
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: