Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | ME121227 | FL |
NPI | 1073878138 |
---|---|
Provider Name | Dr. Zakiya Bomani Moyenda |
First Address | Plantation, FL 33324-1172 |
Second Address | Plantation, FL 33324-1172 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2012 |
Last Update Date | 22/07/2016 |