MEDICARE: RYAN MOCERINO M.D.

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	207R00000X	Internal Medicine Physician	0-945-236-8	ZZ
2	207R00000X	Internal Medicine Physician	309412	NY
3	207R00000X	Internal Medicine Physician	158270	FL

General Provider Information

NPI Number	:	1992169874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN MOCERINO M.D.

Provider Business Mailing Address
First Line	:	1400 NW 12TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33136-1003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 NW 12TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33136-1087
Country	:	US
Telephone Number	:	305-325-5511
Fax Number	:

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

Provider Enumeration Date	:	04/07/2016
Last Update Date	:	12/20/2022

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