Provider Demographics
NPI:1316774375
Name:LONCHONG MORERA, ROBERTO DE JESUS
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:DE JESUS
Last Name:LONCHONG MORERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6691 COW PEN RD APT A212
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6609
Mailing Address - Country:US
Mailing Address - Phone:786-817-9726
Mailing Address - Fax:
Practice Address - Street 1:6691 COW PEN RD APT A212
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6609
Practice Address - Country:US
Practice Address - Phone:786-817-9726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician