Healthcare Provider Details

I. General information

NPI: 1295320638
Provider Name (Legal Business Name): YANIO BRUNELY MORALES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 09/29/2026
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13631 SW 17TH CT
MIRAMAR FL
33027-6469
US

IV. Provider business mailing address

13631 SW 17TH CT
MIRAMAR FL
33027-3449
US

V. Phone/Fax

Practice location:
  • Phone: 786-667-0008
  • Fax:
Mailing address:
  • Phone: 786-667-0008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11026549
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9357422
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: