Provider Demographics
NPI:1760830855
Name:MORALES ESPINOSA, ANA GLORIA
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:GLORIA
Last Name:MORALES ESPINOSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6938 W 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-5247
Mailing Address - Country:US
Mailing Address - Phone:786-262-7342
Mailing Address - Fax:
Practice Address - Street 1:6938 W 30TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-5247
Practice Address - Country:US
Practice Address - Phone:786-262-7342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-30
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019601300Medicaid