Provider Demographics
NPI:1336542703
Name:MOREA, DOREEN (AP 3416)
Entity type:Individual
Prefix:DR
First Name:DOREEN
Middle Name:
Last Name:MOREA
Suffix:
Gender:F
Credentials:AP 3416
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2037 EDGEWATER DR APT 102
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-1057
Mailing Address - Country:US
Mailing Address - Phone:727-771-5004
Mailing Address - Fax:
Practice Address - Street 1:2037 EDGEWATER DR APT 102
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-1057
Practice Address - Country:US
Practice Address - Phone:727-771-5004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP #3416171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist