Healthcare Provider Details

I. General information

NPI: 1114863180
Provider Name (Legal Business Name): ALYSSA MONAYE MORA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 05/10/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 ADAMS AVE STE 16
COSTA MESA CA
92626-3814
US

IV. Provider business mailing address

585 ANTON BLVD UNIT 1304
COSTA MESA CA
92626-1968
US

V. Phone/Fax

Practice location:
  • Phone: 714-723-1466
  • Fax:
Mailing address:
  • Phone: 714-723-1466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: