1376439497 NPI number — STEFANY JULYETH QUICENO MORALES

Table of content: STEFANY JULYETH QUICENO MORALES (NPI 1376439497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376439497 NPI number — STEFANY JULYETH QUICENO MORALES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUICENO MORALES
Provider First Name:
STEFANY
Provider Middle Name:
JULYETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376439497
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
504 DAVIS RD APT 88
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33461-1382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-764-7202
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
931 VILLAGE BLVD
Provider Second Line Business Practice Location Address:
SUITE 905-358
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33409-1803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-764-7202
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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