Provider Demographics
NPI:1578163036
Name:MOSQUEDA, RAYMUNDO LEONARDO (RPH)
Entity Type:Individual
Prefix:
First Name:RAYMUNDO
Middle Name:LEONARDO
Last Name:MOSQUEDA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5810 WORTH PKWY APT 2164
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-5513
Mailing Address - Country:US
Mailing Address - Phone:682-557-6074
Mailing Address - Fax:
Practice Address - Street 1:1515 N LOOP 1604 E
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1431
Practice Address - Country:US
Practice Address - Phone:210-491-9001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62661183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist