Healthcare Provider Details

I. General information

NPI: 1255143715
Provider Name (Legal Business Name): ANA LAURA LA ROSA MOSQUERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3507 LEE BLVD STE 248
LEHIGH ACRES FL
33971-1322
US

IV. Provider business mailing address

8730 SW 133RD AVENUE RD APT 119
MIAMI FL
33183-5351
US

V. Phone/Fax

Practice location:
  • Phone: 239-201-9338
  • Fax:
Mailing address:
  • Phone: 813-568-5085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number25-406218
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: