Provider Demographics
NPI:1780015644
Name:MORENO, ZULLY
Entity Type:Individual
Prefix:
First Name:ZULLY
Middle Name:
Last Name:MORENO
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 1:11110 SW 110TH RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-3124
Mailing Address - Country:US
Mailing Address - Phone:305-279-1999
Mailing Address - Fax:305-459-3270
Practice Address - Street 1:11440 N KENDALL DR
Practice Address - Street 2:SUITE 104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1044
Practice Address - Country:US
Practice Address - Phone:305-279-1999
Practice Address - Fax:305-459-3270
Is Sole Proprietor?:No
Enumeration Date:2013-12-03
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program