Healthcare Provider Details

I. General information

NPI: 1003276601
Provider Name (Legal Business Name): ALEXANDRA ELIZABETH MORA PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2016
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 5TH ST SUITE 658
SANTA ANA CA
92701-4599
US

IV. Provider business mailing address

123 JUPITER ST APT 4
ENCINITAS CA
92024-1452
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-2869
  • Fax:
Mailing address:
  • Phone: 951-206-2539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number43334
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: