Healthcare Provider Details

I. General information

NPI: 1699574798
Provider Name (Legal Business Name): ESTEPHANIE LEE MOSQUERA-ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 E BRANDON BLVD # 4757
BRANDON FL
33511-5509
US

IV. Provider business mailing address

7045 SUMMER HOLLY PL
RIVERVIEW FL
33578-4953
US

V. Phone/Fax

Practice location:
  • Phone: 813-563-2231
  • Fax:
Mailing address:
  • Phone: 813-498-9761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2831489
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: