Provider Demographics
NPI:1376596205
Name:MOYA, ROBERTO ANDRES (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:ANDRES
Last Name:MOYA
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 W 68TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1815
Mailing Address - Country:US
Mailing Address - Phone:305-826-4046
Mailing Address - Fax:305-556-6271
Practice Address - Street 1:2140 W 68TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1815
Practice Address - Country:US
Practice Address - Phone:305-826-4046
Practice Address - Fax:305-556-6271
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31217174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL201488OtherAMERIGROUP PROVIDER #
FL95457OtherBCBS PROVIDER #
FL001237HILHOtherNEIGHBORHHOD PROVIDER #
FL201488OtherAMERIGROUP PROVIDER #
FL001237HILHOtherNEIGHBORHHOD PROVIDER #