Provider Demographics
NPI:1356498695
Name:NAVA-MOSQUERA, DOLORES (MD)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:
Last Name:NAVA-MOSQUERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 12TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-7301
Mailing Address - Country:US
Mailing Address - Phone:727-527-9590
Mailing Address - Fax:727-527-9792
Practice Address - Street 1:6201 12TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-7301
Practice Address - Country:US
Practice Address - Phone:727-527-9590
Practice Address - Fax:727-527-9792
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0027590207R00000X
FLME27590207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038186100Medicaid
FL038186100OtherPCP MEDIPASS
FL01116822OtherAMERIGROUP
FL30207Medicare ID - Type Unspecified
FL038186100Medicaid