MEDICARE: DR. GILDA PRIETO MORENO PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY6323	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487692547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GILDA PRIETO MORENO PSYD

Provider Business Mailing Address
First Line	:	8525 SW 92ND ST
Second Line	:	SUITE A1
City	:	MIAMI
State	:	FL
Zip	:	33156-7365
Country	:	US
Telephone Number	:	305-630-2909
Fax Number	:	305-630-2908

Provider Business Practice Location Address
First Line	:	8525 SW 92ND ST
Second Line	:	SUITE A1
City	:	MIAMI
State	:	FL
Zip	:	33156-7365
Country	:	US
Telephone Number	:	305-630-2909
Fax Number	:	305-630-2908

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	01/26/2010

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