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General NPI Number Information
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NPI Number | 1942789151
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Entity Type | Individual
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Provider Name | KEVIN PATRICIO MORA PA
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Gender | Male
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 111 S GRANT AVE
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City | COLUMBUS
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State | OH
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Zip | 43215-4701
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Country | US
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Telephone | 614-566-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 831 WACKEMAN CT
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City | WESTERVILLE
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State | OH
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Zip | 43081-3779
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Country | US
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Telephone | 614-940-1048
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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