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General NPI Number Information
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NPI Number | 1902395601
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Entity Type | Individual
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Provider Name | LUIS FERNANDO GONZALEZ MOSQUERA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/08/2018
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 400 MILITARY HEIGHTS PL
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City | ROSWELL
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State | NM
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Zip | 88201-6407
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Country | US
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Telephone | 575-627-9110
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Fax | 575-627-9535
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Provider Business Mailing Address
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Address Line | 2800 W GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48202-2610
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Country | US
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Telephone | 888-777-4167
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Fax | 313-916-4989
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 4351048906
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | MD2025-0074
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License Number State | NM
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