Healthcare Provider Details

I. General information

NPI: 1477134641
Provider Name (Legal Business Name): DAVID MOJICA PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N TELEGRAPH RD
PONTIAC MI
48341-1032
US

IV. Provider business mailing address

4038 HORIZON DR
DAVISON MI
48423-8445
US

V. Phone/Fax

Practice location:
  • Phone: 248-858-0581
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number503348
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: