Provider Demographics
NPI:1184413890
Name:MOYA POLANIA, JUAN FELIPE
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:FELIPE
Last Name:MOYA POLANIA
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5811 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-4458
Mailing Address - Country:US
Mailing Address - Phone:813-713-3740
Mailing Address - Fax:
Practice Address - Street 1:5811 BEECH ST
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-4458
Practice Address - Country:US
Practice Address - Phone:813-713-3740
Practice Address - Fax:813-713-3740
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25-250246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant