Healthcare Provider Details

I. General information

NPI: 1477785145
Provider Name (Legal Business Name): FABIAN VICTOR MORALES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2009
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5966 S DIXIE HWY STE 401
SOUTH MIAMI FL
33143-5177
US

IV. Provider business mailing address

5966 S DIXIE HWY STE 401
SOUTH MIAMI FL
33143-5177
US

V. Phone/Fax

Practice location:
  • Phone: 786-453-2667
  • Fax:
Mailing address:
  • Phone: 786-453-2667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberME120474
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number254381-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number25MA08828600
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number98244
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: