Provider Demographics
NPI:1811542806
Name:MOJICA, CAMILO ANDRES (CNIM)
Entity Type:Individual
Prefix:
First Name:CAMILO
Middle Name:ANDRES
Last Name:MOJICA
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 N CENTRAL EXPY UNIT 2586
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-0139
Mailing Address - Country:US
Mailing Address - Phone:303-704-4621
Mailing Address - Fax:
Practice Address - Street 1:925B PEACHTREE ST NE
Practice Address - Street 2:STE 710
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3918
Practice Address - Country:US
Practice Address - Phone:303-704-4621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic