MEDICARE: LUIS MANUEL MARTIN MORALES

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	363LF0000X	Family Nurse Practitioner	F06210540	FL

General Provider Information

NPI Number	:	1841860608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS MANUEL MARTIN MORALES

Provider Business Mailing Address
First Line	:	6464 N MIAMI AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33150-4520
Country	:	US
Telephone Number	:	305-756-8890
Fax Number	:	305-758-5769

Provider Business Practice Location Address
First Line	:	6464 N MIAMI AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33150-4520
Country	:	US
Telephone Number	:	305-756-8890
Fax Number	:	305-758-5769

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

Provider Enumeration Date	:	06/24/2021
Last Update Date	:	07/13/2021

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Directions to “ LUIS MANUEL MARTIN MORALES ” Practice Location

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