Individual
MR. FREDDY MORENO
Active
Individual
MR. FREDDY MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
PA113159
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106071500
—
FL
01
—
O8400
HF MA
FL
Enumeration date
03/06/2020
Last updated
07/12/2024
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