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General NPI Number Information
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NPI Number | 1700499365
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Entity Type | Organization
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Legal Business Name | MOYA MARTIN, LLC.
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Dates
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Enumeration Date | 08/24/2020
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Last Update Date | 10/19/2020
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Provider Practice Location Address
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Address Line | 2247 PALM BEACH LAKES BLVD STE 204B
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-3409
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Country | US
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Telephone | 561-373-7258
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Fax |
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Provider Business Mailing Address
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Address Line | 4680 PORTOFINO WAY # 20-108
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-8168
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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 | MOYA I MARTIN
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Credential | DO
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Telephone | 561-373-7258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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