1760461057 NPI number — CELIA REYES-MOROZ M.D.

Table of content: CELIA REYES-MOROZ M.D. (NPI 1760461057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760461057 NPI number — CELIA REYES-MOROZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYES-MOROZ
Provider First Name:
CELIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REYES
Provider Other First Name:
CELIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1760461057
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1960 NE 47TH ST
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
FT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33308-7708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-493-5005
Provider Business Mailing Address Fax Number:
954-938-0957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1960 NE 47TH ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
FT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33308-7708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-493-5005
Provider Business Practice Location Address Fax Number:
954-938-0957
Provider Enumeration Date:
01/13/2006

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: 207L00000X , with the licence number:  ME33375 , 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)

  • Identifier: 204929 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: D64649 , issued by the state of ( FL ) . This identifiers is of the category "MEDICARE UPIN".
  • Identifier: 050063737 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 93959 . This is a "BCBS OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 035843600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 93959Z , issued by the state of ( FL ) . This identifiers is of the category "MEDICARE ID-TYPE UNSPECIFIED".