Provider Demographics
NPI:1588421861
Name:MOSQUEDA, LETICIA ILIANA
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:ILIANA
Last Name:MOSQUEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13909 SW 174TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-7712
Mailing Address - Country:US
Mailing Address - Phone:954-621-6047
Mailing Address - Fax:
Practice Address - Street 1:11120 N KENDALL DR STE 100
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-0941
Practice Address - Country:US
Practice Address - Phone:305-279-0808
Practice Address - Fax:305-271-4916
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11031609363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily