Healthcare Provider Details

I. General information

NPI: 1487065793
Provider Name (Legal Business Name): MARIANA MORENO PRATS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 WEBBER ST
SARASOTA FL
34239
US

IV. Provider business mailing address

2001 WEBBER ST
SARASOTA FL
34239-5237
US

V. Phone/Fax

Practice location:
  • Phone: 941-362-8900
  • Fax: 941-362-8987
Mailing address:
  • Phone: 941-362-8900
  • Fax: 941-362-8987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME140074
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number10593201-1205
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number10593201-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: