Healthcare Provider Details

I. General information

NPI: 1679027536
Provider Name (Legal Business Name): SARA MARIE MOSQUEDA L.M .T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 STATE ROAD 436 SUITE 1000
WINTER PARK FL
32792-2255
US

IV. Provider business mailing address

1860 STATE ROAD 436 SUITE 1000
WINTER PARK FL
32792-2255
US

V. Phone/Fax

Practice location:
  • Phone: 407-657-5029
  • Fax: 407-657-6320
Mailing address:
  • Phone: 407-657-5029
  • Fax: 407-657-6320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA77432
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: