Healthcare Provider Details

I. General information

NPI: 1225966336
Provider Name (Legal Business Name): MS. SUSAN MORA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 S OGDEN DR
LOS ANGELES CA
90019-5036
US

IV. Provider business mailing address

1775 S OGDEN DR
LOS ANGELES CA
90019-5036
US

V. Phone/Fax

Practice location:
  • Phone: 323-854-6074
  • Fax:
Mailing address:
  • Phone: 323-854-6074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2994
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-01-0713
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: