Provider Demographics
NPI:1063972578
Name:MORALES, MYRA KARINA (MD)
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:KARINA
Last Name:MORALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7261 SHERIDAN ST STE 340
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2726
Mailing Address - Country:US
Mailing Address - Phone:954-561-6222
Mailing Address - Fax:954-990-7650
Practice Address - Street 1:5901 SW 74TH ST STE 408
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5164
Practice Address - Country:US
Practice Address - Phone:305-735-3555
Practice Address - Fax:954-990-7650
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1603202084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118018500Medicaid