Healthcare Provider Details

I. General information

NPI: 1417895681
Provider Name (Legal Business Name): ERICA SARAI MORA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13223 BLACK MOUNTAIN RD # 1508
SAN DIEGO CA
92129-2698
US

IV. Provider business mailing address

5178 COYOTE ST
HEMET CA
92545-9370
US

V. Phone/Fax

Practice location:
  • Phone: 858-753-5082
  • Fax:
Mailing address:
  • Phone: 619-721-7523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number40341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: