MEDICARE: DENISE MORA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1043721814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE MORA

Provider Business Mailing Address
First Line	:	1141 N LOOP 1604 E STE 105-612
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-1339
Country	:	US
Telephone Number	:	210-598-2800
Fax Number	:	210-598-4236

Provider Business Practice Location Address
First Line	:	1141 N LOOP 1604 E
Second Line	:	STE 105-612
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-7823
Country	:	US
Telephone Number	:	210-598-2800
Fax Number	:	210-598-4236

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2017
Last Update Date	:	10/19/2017

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Directions to “ DENISE MORA ” Practice Location

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