Provider Demographics
NPI:1487692547
Name:MORENO, GILDA PRIETO (PSYD)
Entity type:Individual
Prefix:DR
First Name:GILDA
Middle Name:PRIETO
Last Name:MORENO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8525 SW 92ND ST
Mailing Address - Street 2:SUITE A1
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7365
Mailing Address - Country:US
Mailing Address - Phone:305-630-2909
Mailing Address - Fax:305-630-2908
Practice Address - Street 1:8525 SW 92ND ST
Practice Address - Street 2:SUITE A1
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7365
Practice Address - Country:US
Practice Address - Phone:305-630-2909
Practice Address - Fax:305-630-2908
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6323103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6172114Medicare UPIN