Healthcare Provider Details

I. General information

NPI: 1679484778
Provider Name (Legal Business Name): JOSIE MORA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12832 GARDEN GROVE BLVD STE E
GARDEN GROVE CA
92843-2014
US

IV. Provider business mailing address

12832 GARDEN GROVE BLVD STE E
GARDEN GROVE CA
92843-2014
US

V. Phone/Fax

Practice location:
  • Phone: 714-636-1349
  • Fax:
Mailing address:
  • Phone: 714-636-1349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: