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NPI Code Detail

MEDICARE: MARINA MOZQUEDA

MEDICARE: MARINA MOZQUEDA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2172V00000XCommunity Health Worker
3373H00000XDay Training/Habilitation Specialist

General Provider Information

NPI Number : 1306487129
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARINA MOZQUEDA
Provider Business Mailing Address
First Line : 4545 GEORGETOWN PL STE A3
Second Line :
City : STOCKTON
State : CA
Zip : 95207-6228
Country : US
Telephone Number : 209-268-6017
Fax Number :
Provider Business Practice Location Address
First Line : 4545 GEORGETOWN PL STE A3
Second Line :
City : STOCKTON
State : CA
Zip : 95207-6228
Country : US
Telephone Number : 209-808-1631
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2019
Last Update Date : 04/10/2025

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Directions to “ MARINA MOZQUEDA ” Practice Location

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