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General NPI Number Information
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NPI Number | 1063839215
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Entity Type | Organization
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Legal Business Name | MOONSHINE RESEARCH CENTER, INC.
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Dates
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Enumeration Date | 03/26/2014
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Last Update Date | 03/26/2014
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Provider Practice Location Address
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Address Line | 8181 NW 36TH ST SUITE 11
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City | DORAL
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State | FL
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Zip | 33166-6671
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Country | US
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Telephone | 305-463-9368
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Fax | 305-463-9369
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Provider Business Mailing Address
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Address Line | 8181 NW 36TH ST SUITE 11
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City | DORAL
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State | FL
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Zip | 33166-6671
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ANA PIMENTEL
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Credential |
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Telephone | 305-463-9368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1100X
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Taxonomy Name | Research Clinic/Center
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License Number |
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License Number State |
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