Basic Information
| Provider Information | |||||||||
| NPI: | 1083955991 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NOEL MORA, MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7200 CORPORATE CENTER DR | ||||||||
| Address2: | 600 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331261200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055002000 | ||||||||
| FaxNumber: | 3055002080 | ||||||||
| Practice Location | |||||||||
| Address1: | 5201 HOLLYWOOD BLVD | ||||||||
| Address2: | 2 FLOOR | ||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330216422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549815200 | ||||||||
| FaxNumber: | 9549811614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2013 | ||||||||
| LastUpdateDate: | 03/04/2013 | ||||||||
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| AuthorizedOfficialLastName: | LOPEZ | ||||||||
| AuthorizedOfficialFirstName: | HOLLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP SUPPORT SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 3055002108 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CONTINUCARE MEDICAL MANAGEMENT, INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X | ME71747 | FL | Y | Suppliers | Non-Pharmacy Dispensing Site |
No ID Information.