Healthcare Provider Details

I. General information

NPI: 1790423549
Provider Name (Legal Business Name): YUNIOR MOYA HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5309 FRUITVILLE RD
SARASOTA FL
34232-6402
US

IV. Provider business mailing address

601 S HARBOUR ISLAND BLVD STE 200
TAMPA FL
33602-5925
US

V. Phone/Fax

Practice location:
  • Phone: 941-909-7847
  • Fax: 844-388-6186
Mailing address:
  • Phone: 800-480-5243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1599
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: