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General NPI Number Information
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NPI Number | 1689830580
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Entity Type | Organization
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Legal Business Name | DAVID MORENO PLLC
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Dates
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Enumeration Date | 07/31/2008
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 12102 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613-5514
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Country | US
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Telephone | 352-263-1243
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Fax |
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Provider Business Mailing Address
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Address Line | 12102 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613-5514
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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 | OWNER
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Name | DR. DAVID MORENO
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Credential | M.D.
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Telephone | 352-263-1243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME83919
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License Number State | FL
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