Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 12487 | FL |
Y | 111NI0013X | Independent Medical Examiner | 12487 | FL |
NPI | 1336623719 |
---|---|
Provider Name | Dr. J'quyra Dione Moncur-Blue |
First Address | Miami Gardens, FL 33056-2929 |
Second Address | Miami Gardens, FL 33056-2929 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2018 |
Last Update Date | 20/09/2018 |