Individual
EDINSON ANTONIO MATOS-MORENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SA-C
Contact information
Practice address
705 SW 148TH AVE APT 202, DAVIE, FL 33325
(954) 801-8559
Mailing address
701 SW 148TH AVE APT 101, DAVIE, FL 33325-3080
(954) 801-8559
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
14-481
FL
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
06/11/2017
Last updated
07/21/2022
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