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General NPI Number Information
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NPI Number | 1235855644
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Entity Type | Individual
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Provider Name | DAGOBERTO JESUS MORALES OLIVERA APRN
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Gender | Male
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Dates
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Enumeration Date | 10/17/2022
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 15700 NW 67TH AVE STE 101
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2112
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Country | US
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Telephone | 305-621-8051
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Fax |
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Provider Business Mailing Address
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Address Line | 1165 NW 135TH CT
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City | MIAMI
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State | FL
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Zip | 33182-2615
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Country | US
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Telephone | 786-547-8394
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11022010
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License Number State | FL
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