MEDICARE: MS. BERNADETTE MOSQUERA LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AP1720	FL

General Provider Information

NPI Number	:	1326154675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BERNADETTE MOSQUERA LAC

Provider Business Mailing Address
First Line	:	2208 NE 17TH TERRACE
Second Line	:
City	:	WILTON MANORS
State	:	FL
Zip	:	33305
Country	:	US
Telephone Number	:	954-609-7702
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 NE 26TH STREET
Second Line	:	SUITE 101
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33305
Country	:	US
Telephone Number	:	954-564-6573
Fax Number	:	954-564-6513

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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