Provider Demographics
NPI:1376224543
Name:HECHAVARRIA MOSQUEDA, MAIDRET
Entity Type:Individual
Prefix:
First Name:MAIDRET
Middle Name:
Last Name:HECHAVARRIA 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 1:413 NW 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-7665
Mailing Address - Country:US
Mailing Address - Phone:239-671-0679
Mailing Address - Fax:
Practice Address - Street 1:5425 GOLDEN GATE PKWY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-7524
Practice Address - Country:US
Practice Address - Phone:239-778-8455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-286607106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician