Provider Demographics
NPI:1730135435
Name:MORENO, EDUARDO C (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:C
Last Name:MORENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 CELEBRATION BLVD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5159
Mailing Address - Country:US
Mailing Address - Phone:407-520-5845
Mailing Address - Fax:
Practice Address - Street 1:4553 PLEASANT HILL RD
Practice Address - Street 2:SUITE A
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759
Practice Address - Country:US
Practice Address - Phone:407-870-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0029790208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279674100Medicaid
FLE56362Medicare UPIN
FL53533YMedicare PIN