MEDICARE: LOURDES F MOSQUEDA MD

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	208000000X	Pediatrics Physician	A60331	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962557108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOURDES F MOSQUEDA MD

Provider Business Mailing Address
First Line	:	1945 N FINE AVE
Second Line	:	SUITE 116
City	:	FRESNO
State	:	CA
Zip	:	93727-1528
Country	:	US
Telephone Number	:	559-457-6900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3727 N FIRST STREET
Second Line	:	STE 106
City	:	FRESNO
State	:	CA
Zip	:	93726-5628
Country	:	US
Telephone Number	:	559-457-6900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	08/14/2008

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