Provider Demographics
NPI:1821337007
Name:MOSQUERA, DIEGO ALBERTO (REGISTERED)
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:ALBERTO
Last Name:MOSQUERA
Suffix:
Gender:M
Credentials:REGISTERED
Other - Prefix:
Other - First Name:DIEGO
Other - Middle Name:ALBERTO
Other - Last Name:MOSQUERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED
Mailing Address - Street 1:6265 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1114
Mailing Address - Country:US
Mailing Address - Phone:818-779-0555
Mailing Address - Fax:
Practice Address - Street 1:6265 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1114
Practice Address - Country:US
Practice Address - Phone:818-779-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)