Provider Demographics
NPI:1043101504
Name:MORENO TOLOSA, JULIET MILENA (SA-C)
Entity type:Individual
Prefix:
First Name:JULIET
Middle Name:MILENA
Last Name:MORENO TOLOSA
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14050 BISCAYNE BLVD APT 216
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33181-1539
Mailing Address - Country:US
Mailing Address - Phone:786-658-4775
Mailing Address - Fax:
Practice Address - Street 1:14050 BISCAYNE BLVD APT 216
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33181-1539
Practice Address - Country:US
Practice Address - Phone:786-658-4775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21-543246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant