Basic Information
| Provider Information | |||||||||
| NPI: | 1225656382 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORALES | ||||||||
| FirstName: | DAGOBERTO | ||||||||
| MiddleName: | JESUS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1165 NW 135TH CT | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331822615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7865478395 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2001 W 68TH ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330161898 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053642107 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2020 | ||||||||
| LastUpdateDate: | 04/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.