Provider Demographics
NPI:1144117649
Name:MOJICA, LYDIA SOPHIA
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:SOPHIA
Last Name:MOJICA
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 ESPANOLA WAY
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4103
Mailing Address - Country:US
Mailing Address - Phone:407-738-9978
Mailing Address - Fax:
Practice Address - Street 1:807 ESPANOLA WAY
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4103
Practice Address - Country:US
Practice Address - Phone:407-738-9978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLW4B8F9R2246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy