MEDICARE: OLGA Y MORA NP

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	363LF0000X	Family Nurse Practitioner	439453	TX

General Provider Information

NPI Number	:	1346297702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLGA Y MORA NP

Provider Business Mailing Address
First Line	:	1700 WEST LOOP SOUTH
Second Line	:	STE 400B
City	:	HOUSTON
State	:	TX
Zip	:	77027
Country	:	US
Telephone Number	:	281-444-1738
Fax Number	:	281-444-3084

Provider Business Practice Location Address
First Line	:	3450 FM 1960 W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068
Country	:	US
Telephone Number	:	281-444-1738
Fax Number	:	281-444-3084

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	09/14/2009

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