Healthcare Provider Details

I. General information

NPI: 1477010007
Provider Name (Legal Business Name): ARACELY MORA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8616 LA TIJERA BLVD STE 200
LOS ANGELES CA
90045-3945
US

IV. Provider business mailing address

8616 LA TIJERA BLVD STE 200
LOS ANGELES CA
90045-3945
US

V. Phone/Fax

Practice location:
  • Phone: 310-337-1550
  • Fax: 310-337-2805
Mailing address:
  • Phone: 310-337-1550
  • Fax: 310-337-2805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: