Healthcare Provider Details

I. General information

NPI: 1275052441
Provider Name (Legal Business Name): VICKY MORA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 09/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2608 CENTRAL AVE STE 1
UNION CITY CA
94587-3148
US

IV. Provider business mailing address

5674 STONERIDGE DR STE 207
PLEASANTON CA
94588-8592
US

V. Phone/Fax

Practice location:
  • Phone: 510-675-0600
  • Fax:
Mailing address:
  • Phone: 925-520-0005
  • Fax: 925-520-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number546019
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: