Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | ME90254 | FL |
NPI | 1003874454 |
---|---|
Provider Name | Dr. Orlando C. Moreno |
First Address | Miami Lakes, FL 33014-6047 |
Second Address | Hialeah, FL 33013-1814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 10/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
268599000 | (05) | FL |
H85084 | (02) | FL |