Provider Demographics
NPI:1003874454
Name:MORENO, ORLANDO C (MD)
Entity Type:Individual
Prefix:DR
First Name:ORLANDO
Middle Name:C
Last Name:MORENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:16415 DUNOON CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6047
Mailing Address - Country:US
Mailing Address - Phone:305-820-0704
Mailing Address - Fax:305-698-7780
Practice Address - Street 1:4835 E 4TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1814
Practice Address - Country:US
Practice Address - Phone:786-431-1376
Practice Address - Fax:786-431-1377
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME90254207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268599000Medicaid
FLH85084Medicare UPIN
FL268599000Medicaid