Individual
DR. LUIS ANTONIO MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2984 S RIDGEWOOD AVE STE 1, EDGEWATER, FL 32141-7515
(386) 428-4640
(386) 426-1409
Mailing address
845 CRESTWOOD AVE, TITUSVILLE, FL 32796-2265
(321) 867-3827
(321) 867-9198
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
ME 88233
FL
208D00000X
General Practice Physician
Primary
ME88233
FL
Other
Enumeration date
05/08/2007
Last updated
11/16/2021
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