Healthcare Provider Details

I. General information

NPI: 1467055699
Provider Name (Legal Business Name): ROSENDA MORA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15095 AMARGOSA RD
VICTORVILLE CA
92394-1879
US

IV. Provider business mailing address

15095 AMARGOSA RD STE 201
VICTORVILLE CA
92394-1875
US

V. Phone/Fax

Practice location:
  • Phone: 760-245-9546
  • Fax:
Mailing address:
  • Phone: 760-245-9546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: