Provider Demographics
NPI:1659962868
Name:MOJICA, LAURA L (APRN, IBCLC, CPNP-PC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:MOJICA
Suffix:
Gender:F
Credentials:APRN, IBCLC, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3151 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:HYDESVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95547-9449
Mailing Address - Country:US
Mailing Address - Phone:707-599-9263
Mailing Address - Fax:
Practice Address - Street 1:3305 RENNER DR
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-3119
Practice Address - Country:US
Practice Address - Phone:707-725-9355
Practice Address - Fax:707-725-2426
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-30
Last Update Date:2022-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017325363LP0200X
CA605126163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics