Provider Demographics
NPI:1235855644
Name:MORALES OLIVERA, DAGOBERTO JESUS (APRN)
Entity Type:Individual
Prefix:
First Name:DAGOBERTO
Middle Name:JESUS
Last Name:MORALES OLIVERA
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 1:1165 NW 135TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-2615
Mailing Address - Country:US
Mailing Address - Phone:786-547-8394
Mailing Address - Fax:
Practice Address - Street 1:15700 NW 67TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2112
Practice Address - Country:US
Practice Address - Phone:305-621-8051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11022010363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily