Provider Demographics
NPI:1780447524
Name:MOSQUERA-MUNOZ, JULIAN ANDRES
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:ANDRES
Last Name:MOSQUERA-MUNOZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 W 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-1056
Mailing Address - Country:US
Mailing Address - Phone:614-733-1078
Mailing Address - Fax:
Practice Address - Street 1:139 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:PLAIN CITY
Practice Address - State:OH
Practice Address - Zip Code:43064-1056
Practice Address - Country:US
Practice Address - Phone:614-733-1078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHUL931645172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver