EDINSON ANTONIO MATOS-MORENO (NPI# 1174052229) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174052229 |
| Entity Type | Individual |
| Full Name | EDINSON ANTONIO MATOS-MORENO |
| Credential | SA-C |
| Practice Address |
705 Sw 148th Ave Apt 202 Davie FL 33325 |
| Mailing Address |
701 Sw 148th Ave Apt 101 Davie FL 33325-3080 |
| Practice Telephone | (954) 801-8559 |
| Mailing Telephone | 9548018559 |
| Enumeration Date | 2017-06-11 |
| Last Update Date | 2018-06-19 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 246ZC0007X |
Specialist/Technologist, Other Specialization: Surgical Assistant |
14-481 | FL | Technologists, Technicians & Other Technical Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 705 Sw 148th Ave Apt 202, Davie, FL 333253081 | (954) 801-8559 |
| Street Address |
705 SW 148TH AVE APT 202 |
| City | DAVIE |
| State | FL |
| Zip Code | 33325 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588273437 | Gabriela Avila- Garcia | Behavior Technician | 440 Sawgrass Corporate Parkway Suite 106, Sunrise, FL 33325 | 2020-07-27 |
| 1174002711 | Susana Potter | Counselor | 11913 Sw 13th Ct, Davie, FL 33325 | 2018-08-13 |
| 1871015701 | Veredy S.a.s LLC | Specialist/Technologist, Other | 705 Sw 148 Av Apt 202, Davie, FL 33325 | 2017-07-12 |
| 1861922205 | Veronica Ivonne Franco-saavedra | Physician Assistant | 701 Sw 148th Ave Apt 101, Davie, FL 33325 | 2017-06-18 |
| 1457887523 | Caribbean Pediatrics Inc | Exclusive Provider Organization | 11750 Nw 6th Place, Plantation, FL 33325 | 2017-05-10 |
| 1639605058 | Scott Rosiere | Psychologist | 480 West Mount Vernon Drive, Plantation, FL 33325 | 2017-05-04 |
| 1457896458 | New Life Counseling Inc. | Counselor | 1775 S. Flamingo Rd, Suite 1, Davie, FL 33325 | 2016-12-29 |
| 1821541541 | Heather Contreras | Physician Assistant | 11352 W State Road 84 Unit 1, Davie, FL 33325 | 2016-07-28 |
| 1568822070 | Martha Falconi | Acupuncturist | 13224 W. Broward Blvd., Plantation, FL 33325 | 2016-02-25 |
| 1942675038 | Thomas Fordham Brewer, M.d., Inc. | Family Medicine | 13630 Nw 8th St Suite 205, Sunrise, FL 33325 | 2015-12-01 |
| Find all providers in zip 33325 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861922205 | Veronica Ivonne Franco-saavedra | Physician Assistant | 701 Sw 148th Ave Apt 101, Davie, FL 33325 | 2017-06-18 |
| 1821541541 | Heather Contreras | Physician Assistant | 11352 W State Road 84 Unit 1, Davie, FL 33325 | 2016-07-28 |
| 1235256249 | Barbara J. Fish | Physician Assistant | 1700 Sw 100th Ter, Davie, FL 33324-7474 | 2007-03-23 |
| 1639238413 | Horacio Garcia Oconnor | Physician Assistant | 8121 Bermuda Point Ln, Davie, FL 33328-3023 | 2006-12-07 |
| 1528582665 | Hc Surgical LLC | Physician Assistant | 11352 W State Road 84 Unit 1, Davie, FL 33325 | 2017-07-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811598691 | Monica Nancy Ginocchio | Physician Assistant | 1020 Crosspointe Dr Ste 110, Naples, FL 34110-0918 | 2020-11-06 |
| 1427657055 | Alyson Ryall | Physician Assistant | 480 Ventura Pl, Vero Beach, FL 32963-4262 | 2020-10-24 |
| 1104436476 | Forrest Joseph Steslow | Physician Assistant | 1971 Brandywine Rd Apt 305, West Palm Beach, FL 33409-6800 | 2020-08-03 |
| 1063039576 | Joshua Bras Prewitt | Physician Assistant | 4800 Linton Blvd Ste 201, Delray Beach, FL 33445-6584 | 2020-06-30 |
| 1003443904 | Sheila Rhinehart | Physician Assistant | 981 Tarpon Ave, Sebastian, FL 32958-5147 | 2020-03-23 |
| 1952932493 | Lisel Spieler | Physician Assistant | 1173 Fins Up Ct, Daytona Beach, FL 32124-3719 | 2020-02-03 |
| 1326685991 | Nikolai X Lincavage | Physician Assistant | 29277 Us Highway 19 N # 29277, Clearwater, FL 33761-2102 | 2019-12-03 |
| 1356984686 | Zane K Jude | Physician Assistant | 1775 Linton Lake Dr, Delray Beach, FL 33445-6927 | 2019-10-18 |
| 1720635998 | Jose R Munoz | Physician Assistant | 4801 Esedra Ct Apt 203, Lake Worth, FL 33467-5019 | 2019-08-22 |
| 1811559578 | Sydney Gillen | Physician Assistant | 1222 S Orange Ave Fl 2, Orlando, FL 32806-1215 | 2019-07-02 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on EDINSON ANTONIO MATOS-MORENO.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.