Provider Demographics
NPI:1316790793
Name:FREIRE DE FREITAS MORENO, MARIELLA (MD)
Entity type:Individual
Prefix:
First Name:MARIELLA
Middle Name:
Last Name:FREIRE DE FREITAS MORENO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIELLA
Other - Middle Name:
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6705 BURNLEY LN
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-7388
Mailing Address - Country:US
Mailing Address - Phone:321-418-9098
Mailing Address - Fax:
Practice Address - Street 1:1475 W 49TH PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3113
Practice Address - Country:US
Practice Address - Phone:305-558-1722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program