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General NPI Number Information
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NPI Number | 1669533774
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Entity Type | Organization
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Legal Business Name | CLINICA MEDICA DE LA MORA INC
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 995 GATEWAY CENTER WAY STE 202
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City | SAN DIEGO
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State | CA
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Zip | 92102-4545
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Country | US
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Telephone | 619-264-3107
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Fax | 619-264-6927
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Provider Business Mailing Address
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Address Line | 995 GATEWAY CENTER WAY STE 202
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City | SAN DIEGO
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State | CA
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Zip | 92102-4545
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Country | US
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Telephone | 619-264-3107
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Fax | 619-264-6927
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | FERNANDO BECERRA
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Credential |
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Telephone | 619-264-3107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A507691
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License Number State | CA
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