Healthcare Provider Details

I. General information

NPI: 1770252660
Provider Name (Legal Business Name): STEPHANIE MORA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6770 N WEST AVE
FRESNO CA
93711-1399
US

IV. Provider business mailing address

1055 E COLORADO BLVD
PASADENA CA
91106-2327
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-6780
  • Fax:
Mailing address:
  • Phone: 818-241-6853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: