Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 9474 | TX |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 9474 | TX |
NPI | 1336625359 |
---|---|
Provider Name | Carmen Lucero Mosqueda |
First Address | Houston, TX 77012-3130 |
Second Address | El Paso, TX 79912-5526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2018 |
Last Update Date | 12/07/2018 |