Provider Demographics
NPI:1861510315
Name:MOSQUERA, FEDERICO IVOR (MD, LSA)
Entity Type:Individual
Prefix:
First Name:FEDERICO
Middle Name:IVOR
Last Name:MOSQUERA
Suffix:
Gender:M
Credentials:MD, LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 690171
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77269-0171
Mailing Address - Country:US
Mailing Address - Phone:832-493-3204
Mailing Address - Fax:
Practice Address - Street 1:17307 ELVERSON OAKS DR
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-1260
Practice Address - Country:US
Practice Address - Phone:832-493-3204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00134208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery