Provider Demographics
NPI:1710135397
Name:MORENO, MARIA ANGELA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA ANGELA
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8819 BEL MEADOW WAY
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4605
Mailing Address - Country:US
Mailing Address - Phone:917-345-5483
Mailing Address - Fax:
Practice Address - Street 1:8819 BEL MEADOW WAY
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4605
Practice Address - Country:US
Practice Address - Phone:917-345-5483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165680207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine