Provider Demographics
NPI:1053927756
Name:MOJICA, FLORENCE A
Entity type:Individual
Prefix:
First Name:FLORENCE
Middle Name:A
Last Name:MOJICA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-7174
Mailing Address - Country:US
Mailing Address - Phone:310-592-5338
Mailing Address - Fax:844-970-1027
Practice Address - Street 1:1651 ROSE AVE
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-7174
Practice Address - Country:US
Practice Address - Phone:310-592-5338
Practice Address - Fax:844-970-1027
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6036944740376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator