Provider Demographics
NPI:1518584465
Name:MOINO, VERONICA ELENA (DO)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:ELENA
Last Name:MOINO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:INTERNAL MEDICINE CENTER
Mailing Address - Street 2:1801 SUNSET DRIVE
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:954-707-3093
Mailing Address - Fax:803-434-4160
Practice Address - Street 1:INTERNAL MEDICINE CENTER
Practice Address - Street 2:1801 SUNSET DRIVE
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:954-707-3093
Practice Address - Fax:803-434-4160
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCLL83275207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine