Healthcare Provider Details

I. General information

NPI: 1184413890
Provider Name (Legal Business Name): JUAN FELIPE MOYA POLANIA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5811 BEECH ST
ZEPHYRHILLS FL
33542-4458
US

IV. Provider business mailing address

5811 BEECH ST
ZEPHYRHILLS FL
33542-4458
US

V. Phone/Fax

Practice location:
  • Phone: 813-713-3740
  • Fax: 813-713-3740
Mailing address:
  • Phone: 813-713-3740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number25-250
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: