Healthcare Provider Details

I. General information

NPI: 1225941149
Provider Name (Legal Business Name): NATHANIEL GILBERT MORA LICENSED VOCATIONAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 UNION AVE
SAN JOSE CA
95124-5156
US

IV. Provider business mailing address

4850 UNION AVE
SAN JOSE CA
95124-5156
US

V. Phone/Fax

Practice location:
  • Phone: 800-913-2615
  • Fax: 408-559-3158
Mailing address:
  • Phone: 800-913-2615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number715565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: