MEDICARE: MS. SUSAN MORA

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	101Y00000X	Counselor	2994
2	103K00000X	Behavior Analyst	1-01-0713	CA

General Provider Information

NPI Number	:	1225966336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN MORA

Provider Business Mailing Address
First Line	:	1775 S OGDEN DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-5036
Country	:	US
Telephone Number	:	323-854-6074
Fax Number	:

Provider Business Practice Location Address
First Line	:	1775 S OGDEN DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-5036
Country	:	US
Telephone Number	:	323-854-6074
Fax Number	:

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

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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