Provider Demographics
NPI:1669297321
Name:MOREJON GROSS, ANGEL ABDEL
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:ABDEL
Last Name:MOREJON GROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4326 W FLAGLER ST APT 5
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1589
Mailing Address - Country:US
Mailing Address - Phone:346-640-4958
Mailing Address - Fax:
Practice Address - Street 1:4326 W FLAGLER ST APT 5
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1589
Practice Address - Country:US
Practice Address - Phone:346-640-4958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-390962106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician