Individual
BENJAMIN MORENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4543 PLEASANT HILL RD, KISSIMMEE, FL 34759-3403
(407) 933-7900
Mailing address
4543 PLEASANT HILL RD, STE A, KISSIMMEE, FL 34759-3403
(407) 933-7900
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
16431
PR
208D00000X
General Practice Physician
Primary
ACN326
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005544500
—
FL
01
—
24403MO
TRIPLES
PR
01
—
ACN326
MEDICAL LICENSE NUMBER
FL
Enumeration date
05/16/2006
Last updated
11/23/2016
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