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General NPI Number Information
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NPI Number | 1497433221
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Entity Type | Individual
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Provider Name | MOISE JOSEPH
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Gender | Male
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Dates
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Enumeration Date | 07/11/2023
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 20200 W DIXIE HWY STE 902
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City | AVENTURA
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State | FL
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Zip | 33180-1926
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Country | US
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Telephone | 804-347-5052
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Fax |
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Provider Business Mailing Address
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Address Line | 5108 ACOMA AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32210-7970
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Country | US
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Telephone | 804-347-5052
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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 | 172A00000X
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Taxonomy Name | Driver
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License Number | J210-540-81-296-0
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License Number State | FL
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