Provider Demographics
NPI:1598358228
Name:MORENO MATOS, ASDRUBAL (APRN)
Entity Type:Individual
Prefix:
First Name:ASDRUBAL
Middle Name:
Last Name:MORENO MATOS
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 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:305-949-0999
Mailing Address - Fax:305-748-6282
Practice Address - Street 1:1431 NE 162ND ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4620
Practice Address - Country:US
Practice Address - Phone:305-949-0999
Practice Address - Fax:305-748-6282
Is Sole Proprietor?:No
Enumeration Date:2021-02-13
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011413363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily