Healthcare Provider Details

I. General information

NPI: 1962325092
Provider Name (Legal Business Name): ALEJANDRO MORA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 BENTON ST
LOMA LINDA CA
92357-1000
US

IV. Provider business mailing address

12022 BUTTERFIELD PL
CHINO CA
91710-1835
US

V. Phone/Fax

Practice location:
  • Phone: 909-561-5550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberINT51652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: