Healthcare Provider Details

I. General information

NPI: 1801885843
Provider Name (Legal Business Name): SEBASTIAN A MORA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 FLOYD CURL DR FL 6
SAN ANTONIO TX
78229-3931
US

IV. Provider business mailing address

7703 FLOYD CURL DR
SAN ANTONIO TX
78229-3901
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-9400
  • Fax: 210-450-6024
Mailing address:
  • Phone: 210-450-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberE0563
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: