Provider Demographics
NPI:1437680097
Name:MOREJON, CHRISTIAN O
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:O
Last Name:MOREJON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11180 W FLAGLER ST
Mailing Address - Street 2:14
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1216
Mailing Address - Country:US
Mailing Address - Phone:786-318-9544
Mailing Address - Fax:786-318-9544
Practice Address - Street 1:11180 W FLAGLER ST
Practice Address - Street 2:14
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1216
Practice Address - Country:US
Practice Address - Phone:786-318-9544
Practice Address - Fax:786-318-9544
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA83614390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty