Provider Demographics
NPI:1831409945
Name:GILDA P MORENO PSY D PA
Entity type:Organization
Organization Name:GILDA P MORENO PSY D PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GILDA
Authorized Official - Middle Name:P
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-630-2909
Mailing Address - Street 1:8525 SW 92ND ST
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7365
Mailing Address - Country:US
Mailing Address - Phone:305-630-2909
Mailing Address - Fax:305-630-2908
Practice Address - Street 1:8525 SW 92ND ST
Practice Address - Street 2:SUITE A-1
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7365
Practice Address - Country:US
Practice Address - Phone:305-630-2909
Practice Address - Fax:305-630-2908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty