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General NPI Number Information
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NPI Number | 1255580437
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Entity Type | Organization
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Legal Business Name | ANTONIO MORA MD PA
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Dates
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Enumeration Date | 09/12/2008
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Last Update Date | 09/12/2008
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Provider Practice Location Address
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Address Line | 1435 W 49TH PL SUITE 305
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City | HIALEAH
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State | FL
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Zip | 33012-3197
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Country | US
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Telephone | 305-251-3991
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Fax | 305-251-7982
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Provider Business Mailing Address
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Address Line | 1435 W 49TH PL SUITE 305
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City | HIALEAH
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State | FL
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Zip | 33012-3197
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Country | US
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Telephone | 305-251-3991
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Fax | 305-251-7982
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | ANTONIO MORA
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Credential | MD
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Telephone | 305-251-3991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME0056780
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License Number State | FL
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