Provider Demographics
NPI:1366003113
Name:MORALES, GENESIS TANAIDI (OD)
Entity type:Individual
Prefix:MRS
First Name:GENESIS
Middle Name:TANAIDI
Last Name:MORALES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9980 SW 14TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2862
Mailing Address - Country:US
Mailing Address - Phone:786-334-8170
Mailing Address - Fax:
Practice Address - Street 1:10521 N KENDALL DR STE E103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1554
Practice Address - Country:US
Practice Address - Phone:305-279-2212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5682152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist