Individual
TANIA MORALES MIEDICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2704 N TENAYA WAY, SUITE 200, LAS VEGAS, NV 89128-0424
(702) 243-8500
(702) 560-2928
Mailing address
PO BOX 15645, LAS VEGAS, NV 89114-5645
(702) 243-8500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME96208
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000320600
—
FL
01
—
1255484390
MEDICAID SMA
NV
05
—
1255484390
—
NV
01
—
13380
NV STATE LICENSE
NV
01
—
92196
BCBS
FL
01
—
CX4402
MEDICARE SMA
NV
Enumeration date
01/20/2007
Last updated
04/02/2014
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