| Moderna Health Clinic | |
|
22 Broadway Ste 111 Kissimmee FL 34741-5408 | |
| (407) 502-2520 | |
| (610) 638-0835 |
| Full Name | Moderna Health Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 22 Broadway Ste 111, Kissimmee, Florida |
| Authorized Official Name and Position | Jonathan Torres (CEO) |
| Authorized Official Contact | 4079221184 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Moderna Health Clinic 464 Sardinia Cir Davenport FL 33837-5863 Ph: (407) 502-2520 | Moderna Health Clinic 22 Broadway Ste 111 Kissimmee FL 34741-5408 Ph: (407) 502-2520 |
| NPI Number | 1467033415 |
|---|---|
| Provider Enumeration Date | 04/20/2021 |
| Last Update Date | 06/05/2023 |
| Medicare PECOS PAC ID | 1153715347 |
|---|---|
| Medicare Enrollment ID | O20220304000895 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467033415 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Jonathan Torres Pabon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831738483 PECOS PAC ID: 3476983271 Enrollment ID: I20200418000246 |
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