Provider Demographics
NPI:1164318002
Name:MORA CENTENO, ANDRES ELOY SR
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:ELOY
Last Name:MORA CENTENO
Suffix:SR
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 1:540 NW 7TH ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:FLORIDA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33034-2090
Mailing Address - Country:US
Mailing Address - Phone:786-468-6729
Mailing Address - Fax:
Practice Address - Street 1:540 NW 7TH ST UNIT 3
Practice Address - Street 2:
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-2090
Practice Address - Country:US
Practice Address - Phone:786-468-6729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-17
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11040230363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily