Provider Demographics
NPI:1235855206
Name:LESCAY MOTOLONGO, ANGEL RAFAEL (APRN)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:RAFAEL
Last Name:LESCAY MOTOLONGO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8360 W FLAGLER ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2042
Mailing Address - Country:US
Mailing Address - Phone:305-396-6061
Mailing Address - Fax:305-396-6114
Practice Address - Street 1:8360 W FLAGLER ST STE 100
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2042
Practice Address - Country:US
Practice Address - Phone:305-396-6061
Practice Address - Fax:305-396-6114
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006361363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty