Healthcare Provider Details

I. General information

NPI: 1902653348
Provider Name (Legal Business Name): ESTUARDO JOSE OSORIO MORATAYA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1973 ALOMA AVE
WINTER PARK FL
32792-3222
US

IV. Provider business mailing address

32203 CAROUSEL LN APT 203
LUNENBURG MA
01462-2444
US

V. Phone/Fax

Practice location:
  • Phone: 407-284-3475
  • Fax:
Mailing address:
  • Phone: 346-323-0915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDL100127
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN32044
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: