Healthcare Provider Details

I. General information

NPI: 1477136646
Provider Name (Legal Business Name): MOIRA HOPE TAYLOR-MORA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22365 BARTON RD STE 104
GRAND TERRACE CA
92313-5037
US

IV. Provider business mailing address

1595 W TOWNSEND ST
RIALTO CA
92377-3856
US

V. Phone/Fax

Practice location:
  • Phone: 909-824-2899
  • Fax:
Mailing address:
  • Phone: 626-328-9715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number8460
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: