Provider Demographics
NPI:1932177441
Name:MOJICAR, LUIS ALBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ALBERTO
Last Name:MOJICAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 GENERATION PT
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5918
Mailing Address - Country:US
Mailing Address - Phone:321-337-7060
Mailing Address - Fax:
Practice Address - Street 1:704 GENERATION PT
Practice Address - Street 2:2ND FLOOR
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5918
Practice Address - Country:US
Practice Address - Phone:321-337-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71646207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL080118931OtherRAILROAD MEDICARE
FL2533332-00Medicaid
GA000775101AMedicaid
GA000775101AMedicaid
FL41859Medicare PIN