Healthcare Provider Details

I. General information

NPI: 1174187025
Provider Name (Legal Business Name): LAURA ANGELICA LOPEZ-MORA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2841 G ST
MERCED CA
95340-2133
US

IV. Provider business mailing address

2841 G ST
MERCED CA
95340-2133
US

V. Phone/Fax

Practice location:
  • Phone: 209-722-0202
  • Fax: 209-385-9921
Mailing address:
  • Phone: 209-722-0202
  • Fax: 209-385-9921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: