MEDICARE: NICHOLAS MORA MS, ATC, CES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer		CA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1043024284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS MORA MS, ATC, CES

Provider Business Mailing Address
First Line	:	1040 HOBART ST UNIT 2
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95926-4541
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2380 LAS PLUMAS AVE
Second Line	:
City	:	OROVILLE
State	:	CA
Zip	:	95966-6999
Country	:	US
Telephone Number	:	530-538-2310
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2025
Last Update Date	:	10/16/2025

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