Basic Information
| Provider Information | |||||||||
| NPI: | 1790422038 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOREIRA | ||||||||
| FirstName: | DANIEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | UCONN HEALTH-OUTPATIENT PAVILION | ||||||||
| Address2: | 263 FARMINGTON AVENUE | ||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060308031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606794888 | ||||||||
| FaxNumber: | 8606790134 | ||||||||
| Practice Location | |||||||||
| Address1: | UCONN HEALTH-OUTPATIENT PAVILION | ||||||||
| Address2: | 263 FARMINGTON AVENUE | ||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060308031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606794888 | ||||||||
| FaxNumber: | 8606790134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2022 | ||||||||
| LastUpdateDate: | 06/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/28/2022 | ||||||||
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.