Provider Demographics
NPI:1700023207
Name:MOYA-PRIDA MD
Entity Type:Organization
Organization Name:MOYA-PRIDA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAYNIER
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-776-5822
Mailing Address - Street 1:15761 SW 59TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5510
Mailing Address - Country:US
Mailing Address - Phone:305-776-5822
Mailing Address - Fax:305-380-1488
Practice Address - Street 1:15761 SW 59TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-5510
Practice Address - Country:US
Practice Address - Phone:305-776-5822
Practice Address - Fax:305-380-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center