Healthcare Provider Details

I. General information

NPI: 1902489602
Provider Name (Legal Business Name): SIRNEY RONAL MOYA MA68723
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5011 W HILLSBOROUGH AVE STE M
TAMPA FL
33634-5309
US

IV. Provider business mailing address

4401 LETO LAKES BLVD APT 307
TAMPA FL
33614-3756
US

V. Phone/Fax

Practice location:
  • Phone: 813-249-7374
  • Fax: 813-249-6969
Mailing address:
  • Phone: 239-849-9018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA68723
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: