Healthcare Provider Details

I. General information

NPI: 1033699673
Provider Name (Legal Business Name): TANIA MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4098 NW 3RD ST
MIAMI FL
33126-5726
US

IV. Provider business mailing address

4098 NW 3RD ST
MIAMI FL
33126-5726
US

V. Phone/Fax

Practice location:
  • Phone: 305-775-7663
  • Fax:
Mailing address:
  • Phone: 305-775-7663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: