Provider Demographics
NPI:1790930782
Name:MOSQUERA, ROMER I (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMER
Middle Name:I
Last Name:MOSQUERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROMER
Other - Middle Name:ISAAC
Other - Last Name:MOSQUERA GONZALEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7300 SW 93RD AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3212
Mailing Address - Country:US
Mailing Address - Phone:786-383-0173
Mailing Address - Fax:307-242-1124
Practice Address - Street 1:7300 SW 93RD AVE STE 210
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3212
Practice Address - Country:US
Practice Address - Phone:786-383-0173
Practice Address - Fax:307-242-1124
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-129012084N0400X
FLME1384422084N0600X, 2084P2900X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106208100Medicaid