Provider Demographics
NPI:1972384782
Name:MOZEALOUS, ADELA JULIE
Entity type:Individual
Prefix:
First Name:ADELA
Middle Name:JULIE
Last Name:MOZEALOUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADELA
Other - Middle Name:JULIE
Other - Last Name:PENATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7040 SEMINOLE PRATT WHITNEY RD STE 25-51
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-5714
Mailing Address - Country:US
Mailing Address - Phone:561-462-1332
Mailing Address - Fax:
Practice Address - Street 1:7040 SEMINOLE PRATT WHITNEY RD STE 25-51
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-5714
Practice Address - Country:US
Practice Address - Phone:561-462-1332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver