Healthcare Provider Details

I. General information

NPI: 1962557108
Provider Name (Legal Business Name): LOURDES F MOSQUEDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 FAIR OAKS AVE STE B
SOUTH PASADENA CA
91030-4774
US

IV. Provider business mailing address

1800 FAIR OAKS AVE STE B
SOUTH PASADENA CA
91030-4774
US

V. Phone/Fax

Practice location:
  • Phone: 626-399-0594
  • Fax: 626-313-2834
Mailing address:
  • Phone: 626-399-0594
  • Fax: 626-313-2834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA60331
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: