Healthcare Provider Details

I. General information

NPI: 1508053588
Provider Name (Legal Business Name): MRS. KARINA A MOSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KARINA A MIRANDA

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7305 NORTH MILITARY TRAIL
RIVIERA FL
33410-7417
US

IV. Provider business mailing address

7305 N MILITARY TRAIL
WEST PALM BEACH FL
33410
US

V. Phone/Fax

Practice location:
  • Phone: 561-422-5326
  • Fax: 561-422-7213
Mailing address:
  • Phone: 561-422-5326
  • Fax: 561-422-7213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number130106486239315
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: