Healthcare Provider Details

I. General information

NPI: 1700714060
Provider Name (Legal Business Name): MOSAIC REMEDIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 DIANE AVE
LAS VEGAS NM
87701-4910
US

IV. Provider business mailing address

752 DIANE AVE
LAS VEGAS NM
87701-4910
US

V. Phone/Fax

Practice location:
  • Phone: 562-208-1980
  • Fax:
Mailing address:
  • Phone: 562-208-1980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: VANESSA MARIE COLONNA
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 562-208-1980