Healthcare Provider Details

I. General information

NPI: 1831841188
Provider Name (Legal Business Name): MARIO ABALLE MOSQUEDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BELMONT ST STE A
LABELLE FL
33935-4729
US

IV. Provider business mailing address

621 9TH ST SW
NAPLES FL
34117-2157
US

V. Phone/Fax

Practice location:
  • Phone: 863-674-8585
  • Fax: 863-674-8587
Mailing address:
  • Phone: 239-240-1406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11016492
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: