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General NPI Number Information
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NPI Number | 1497109383
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Entity Type | Organization
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Legal Business Name | GONZALO MOSQUERA MD LLC
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Dates
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Enumeration Date | 04/18/2016
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Last Update Date | 04/18/2016
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Provider Practice Location Address
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Address Line | 6735 CONROY RD STE 419
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City | ORLANDO
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State | FL
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Zip | 32835-3566
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Country | US
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Telephone | 813-380-1761
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Fax |
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Provider Business Mailing Address
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Address Line | 17600 SW 154TH PL
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City | MIAMI
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State | FL
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Zip | 33187-7818
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Country | US
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Telephone | 813-380-1761
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/PRESIDENT
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Name | DR. GONZALO MOSQUERA
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Credential | MD
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Telephone | 813-380-1761
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | ME0071342
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License Number State | FL
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