Provider Demographics
NPI:1659521219
Name:MOONI, ZIDE
Entity Type:Individual
Prefix:
First Name:ZIDE
Middle Name:
Last Name:MOONI
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 1:10651 SW 88TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1545
Mailing Address - Country:US
Mailing Address - Phone:305-596-0858
Mailing Address - Fax:305-596-0858
Practice Address - Street 1:10651 SW 88TH ST STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1545
Practice Address - Country:US
Practice Address - Phone:305-596-0858
Practice Address - Fax:305-596-0858
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1197171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist