Provider Demographics
NPI:1780717017
Name:LOSADA, NELSA CHACON (OD PA)
Entity type:Individual
Prefix:
First Name:NELSA
Middle Name:CHACON
Last Name:LOSADA
Suffix:
Gender:F
Credentials:OD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 VINELAND RD
Mailing Address - Street 2:STE 105
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7829
Mailing Address - Country:US
Mailing Address - Phone:407-370-6800
Mailing Address - Fax:407-370-6823
Practice Address - Street 1:6001 VINELAND RD
Practice Address - Street 2:STE 105
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7829
Practice Address - Country:US
Practice Address - Phone:407-370-6800
Practice Address - Fax:407-370-6823
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2539152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078822800Medicaid
FLU25040Medicaid
FL20308OtherBC/BS
FL20308OtherBC/BS
FL078822800Medicaid