Provider Demographics
NPI:1184208621
Name:MORAN NAVAS, CARLOS VIDAL
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:VIDAL
Last Name:MORAN NAVAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 SW 124TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-2465
Mailing Address - Country:US
Mailing Address - Phone:786-449-0710
Mailing Address - Fax:
Practice Address - Street 1:1048 SW 124TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-2465
Practice Address - Country:US
Practice Address - Phone:786-449-0710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty