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General NPI Number Information
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NPI Number | 1114211992
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Entity Type | Individual
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Provider Name | ANGEL D MORA CRT
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Gender | Male
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Dates
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Enumeration Date | 06/08/2011
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Last Update Date | 02/09/2012
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Provider Practice Location Address
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Address Line | 12420 SW 192ND TER
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City | MIAMI
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State | FL
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Zip | 33177-3800
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Country | US
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Telephone | 786-389-0801
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Fax | 786-429-1701
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Provider Business Mailing Address
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Address Line | 12420 SW 192ND TER
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City | MIAMI
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State | FL
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Zip | 33177-3800
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Country | US
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Telephone | 786-389-0801
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Fax | 786-429-1701
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471C3402X
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Taxonomy Name | Radiography Radiologic Technologist
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License Number | CRT 69470
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License Number State | FL
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