Provider Demographics
NPI:1194021410
Name:MORONTA MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:MORONTA MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORONTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-970-2697
Mailing Address - Street 1:2740 SW 97TH AVE
Mailing Address - Street 2:111
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2681
Mailing Address - Country:US
Mailing Address - Phone:786-970-2697
Mailing Address - Fax:305-222-6003
Practice Address - Street 1:2740 SW 97TH AVE
Practice Address - Street 2:111
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2681
Practice Address - Country:US
Practice Address - Phone:786-970-2697
Practice Address - Fax:305-222-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty