Basic Information
| Provider Information | |||||||||
| NPI: | 1659962868 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOJICA | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | APRN, IBCLC, CPNP-PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3151 JOHNSON RD | ||||||||
| Address2: | |||||||||
| City: | HYDESVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955479449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075999263 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3300 RENNER DR | ||||||||
| Address2: | |||||||||
| City: | FORTUNA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955403120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7077253361 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2021 | ||||||||
| LastUpdateDate: | 05/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 95017325 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 163WL0100X | 605126 | CA | Y | Nursing Service Providers | Registered Nurse | Lactation Consultant |
No ID Information.