MEDICARE: MELIHSSA DYANNE 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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1679200489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELIHSSA DYANNE MORA

Provider Business Mailing Address
First Line	:	300 INTERNATIONAL PKWY STE 200
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5028
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5834 ADENMOOR AVE
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90713-1002
Country	:	US
Telephone Number	:	562-512-0403
Fax Number	:

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

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	05/22/2026

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