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General NPI Number Information
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NPI Number | 1114772241
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Entity Type | Individual
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Provider Name | VICTORIA NELLY MORALES PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 4302 ALTON RD STE 220A220B
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City | MIAMI BEACH
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State | FL
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Zip | 33140-2891
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Country | US
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Telephone | 305-647-6663
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Fax |
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Provider Business Mailing Address
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Address Line | 7313 NW 174TH TER APT 102
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City | HIALEAH
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State | FL
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Zip | 33015-1118
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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 |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9118731
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License Number State | FL
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