Healthcare Provider Details

I. General information

NPI: 1326760661
Provider Name (Legal Business Name): JOSE EDUARDO MOSQUERA LA TORRE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 09/14/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 SOUTH AVE STE G
PENSACOLA FL
32508-5116
US

IV. Provider business mailing address

211 SOUTH AVE STE G
PENSACOLA FL
32508-5116
US

V. Phone/Fax

Practice location:
  • Phone: 850-452-9096
  • Fax:
Mailing address:
  • Phone: 850-452-9096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: