Edinson Antonio Matos-Moreno, SA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Practice address

705 SW 148TH Ave Apt 202
Davie, FL 33325

Phone

(954) 801-8559

NPI assigned

Jun 11, 2017

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Veredy S.a.S LLC

  • Surgical Assistant
  • Davie, FL
  • NPI 1871015701
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1174052229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 SW 148TH AVE APT 101",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333253080",
            "telephone_number": "954-801-8559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 SW 148TH AVE APT 202",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "33325",
            "telephone_number": "954-801-8559"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "705 SW 148th Ave Apt 202",
            "address_purpose": "LOCATION",
            "city": "Davie",
            "state": "FL",
            "postal_code": "333253081",
            "country_code": "US",
            "telephone_number": "954-801-8559",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATOS-MORENO",
        "first_name": "EDINSON",
        "middle_name": "ANTONIO",
        "credential": "SA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-06-11",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "FL",
            "license": "14-481",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Evelyn Mathis, APRN,PMHNP-BC,FNP-BC
• Olga Mathurin
• Melissa Matias
• Matthew Corey Matlock, PTA
• Natalia Sofia Matos Solarte
• Andrew Matos
• Elena Del Carmen Matos
• Juan M Matos
• Matrix Home Care LLC
• Matthew T. Fostier, O.D., P.a.

• Surgical Physician Assistant in Davie, FL
• Providers in Davie, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.