Healthcare Provider Details

I. General information

NPI: 1972814408
Provider Name (Legal Business Name): MICHELLE MARIA MORA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4016 STEPPING STONE CT
VALLEJO CA
94591-6389
US

IV. Provider business mailing address

4016 STEPPING STONE CT
VALLEJO CA
94591-6389
US

V. Phone/Fax

Practice location:
  • Phone: 615-346-8182
  • Fax: 615-829-8970
Mailing address:
  • Phone: 707-225-1330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberDO.17814
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number114210
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number76756
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number5101018913
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036.145494
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberE-10073
License Number StateAR
# 7
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number05-40690
License Number StateKS
# 8
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA-2164-18
License Number StateNM
# 9
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number02005024A
License Number StateIN
# 10
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number308324
License Number StateLA
# 11
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number18811
License Number StateNH
# 12
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberR6847
License Number StateTX
# 13
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number62073
License Number StateCT
# 14
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number7499
License Number StateAZ
# 15
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number20A14840
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: