Healthcare Provider Details

I. General information

NPI: 1053067033
Provider Name (Legal Business Name): TATIANA SIDDIQUI MORA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8787 COMPLEX DR STE 300
SAN DIEGO CA
92123-1453
US

IV. Provider business mailing address

3845 SPRING DR STE 18
SPRING VALLEY CA
91977-1030
US

V. Phone/Fax

Practice location:
  • Phone: 619-787-1090
  • Fax:
Mailing address:
  • Phone: 510-482-2244
  • Fax: 510-488-1960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: