Provider Demographics
NPI:1104116987
Name:MOREJON, VICENTE (THERAPIST)
Entity type:Individual
Prefix:MR
First Name:VICENTE
Middle Name:
Last Name:MOREJON
Suffix:
Gender:M
Credentials:THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8180 NW 36TH ST
Mailing Address - Street 2:SUITE #230
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6645
Mailing Address - Country:US
Mailing Address - Phone:305-418-8878
Mailing Address - Fax:
Practice Address - Street 1:8180 NW 36TH ST
Practice Address - Street 2:SUITE #230
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6645
Practice Address - Country:US
Practice Address - Phone:305-418-8878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA57611261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center