Healthcare Provider Details

I. General information

NPI: 1568824092
Provider Name (Legal Business Name): ANN MARIE MOJICA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN COLON

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S ANDREWS AVE
FORT LAUDERDALE FL
33316-2510
US

IV. Provider business mailing address

1700 NW 49TH ST STE 125
FORT LAUDERDALE FL
33309-3750
US

V. Phone/Fax

Practice location:
  • Phone: 954-355-4527
  • Fax: 954-712-6688
Mailing address:
  • Phone: 954-355-4527
  • Fax: 954-712-6688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberS1868
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number11778306-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: