Provider Demographics
NPI:1215525928
Name:MOSCOSO, KRISTEL SUZETTE
Entity type:Individual
Prefix:
First Name:KRISTEL
Middle Name:SUZETTE
Last Name:MOSCOSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 ORIENTAL BLVD
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-2441
Mailing Address - Country:US
Mailing Address - Phone:786-920-9050
Mailing Address - Fax:
Practice Address - Street 1:900 W 49TH ST STE 332
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3489
Practice Address - Country:US
Practice Address - Phone:786-789-5305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant