MEDICARE: GONZALO MOSQUERA MD LLC

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
1	261Q00000X	Clinic/Center	ME0071342	FL

General Provider Information

NPI Number	:	1497109383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GONZALO MOSQUERA MD LLC

Provider Business Mailing Address
First Line	:	17600 SW 154TH PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33187-7818
Country	:	US
Telephone Number	:	813-380-1761
Fax Number	:

Provider Business Practice Location Address
First Line	:	6735 CONROY RD STE 419
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-3566
Country	:	US
Telephone Number	:	813-380-1761
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR/PRESIDENT
Name	:	DR. GONZALO MOSQUERA
Credential	:	MD
Telephone Number	:	813-380-1761

Provider Enumeration Date	:	04/18/2016
Last Update Date	:	04/18/2016

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