Provider Demographics
NPI:1689459992
Name:MOJICA GAMBOA, LUZ ELENA
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:ELENA
Last Name:MOJICA GAMBOA
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 1:9874 NAMASTE LOOP APT 4116
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-5545
Mailing Address - Country:US
Mailing Address - Phone:407-793-3836
Mailing Address - Fax:
Practice Address - Street 1:9874 NAMASTE LOOP APT 4116
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-5545
Practice Address - Country:US
Practice Address - Phone:407-793-3836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health