Basic Information
| Provider Information | |||||||||
| NPI: | 1932612611 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOSQUERA COCHRAN | ||||||||
| FirstName: | MARY | ||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 ACKERMAN RD STE 570 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432021579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142937677 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1800 ZOLLINGER RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432212849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142930385 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2017 | ||||||||
| LastUpdateDate: | 01/22/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | LD08315 | OH | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.