Provider Demographics
NPI:1700201779
Name:MOSQUEDA, BEVERLY BALAMAD (NP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:BALAMAD
Last Name:MOSQUEDA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:BALAMAD
Other - Last Name:TSUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:9471 JACK RABBIT DR
Mailing Address - Street 2:104
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-2776
Mailing Address - Country:US
Mailing Address - Phone:626-384-1585
Mailing Address - Fax:
Practice Address - Street 1:9471 JACK RABBIT DR
Practice Address - Street 2:104
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-2776
Practice Address - Country:US
Practice Address - Phone:626-384-1585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000445363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily