Healthcare Provider Details

I. General information

NPI: 1467195396
Provider Name (Legal Business Name): JAN ALBERTO PAREDES MOGICA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 GRANT ST BRIDGEPORT HOSPITAL, DPT OF INTERNAL MEDICINE
BRIDGEPORT CT
06610
US

IV. Provider business mailing address

267 GRANT ST BRIDGEPORT HOSPITAL, DPT OF INTERNAL MEDICINE
BRIDGEPORT CT
06610
US

V. Phone/Fax

Practice location:
  • Phone: 203-384-3446
  • Fax:
Mailing address:
  • Phone: 203-384-3446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number80438
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number80438
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: