Provider Demographics
NPI:1275588279
Name:ORLANDO C. MORENO, M.D. P.A.
Entity Type:Organization
Organization Name:ORLANDO C. MORENO, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:CANDELARIO
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-820-0704
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90254207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8365Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION #