Provider Demographics
NPI:1699574798
Name:MOSQUERA-ORTIZ, ESTEPHANIE LEE
Entity type:Individual
Prefix:
First Name:ESTEPHANIE
Middle Name:LEE
Last Name:MOSQUERA-ORTIZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:792 W LUMSDEN RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6260
Mailing Address - Country:US
Mailing Address - Phone:813-324-7538
Mailing Address - Fax:813-324-7538
Practice Address - Street 1:792 W LUMSDEN RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6260
Practice Address - Country:US
Practice Address - Phone:813-324-7538
Practice Address - Fax:813-324-7538
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician