1194021410 NPI number — MORONTA MEDICAL GROUP INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194021410 NPI number — MORONTA MEDICAL GROUP INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORONTA MEDICAL GROUP INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1194021410
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2740 SW 97TH AVE
Provider Second Line Business Mailing Address:
111
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33165-2681
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-970-2697
Provider Business Mailing Address Fax Number:
305-222-6003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2740 SW 97TH AVE
Provider Second Line Business Practice Location Address:
111
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33165-2681
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-970-2697
Provider Business Practice Location Address Fax Number:
305-222-6003
Provider Enumeration Date:
02/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MORONTA
Authorized Official First Name:
AMELIA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
786-970-2697

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com