MEDICARE: MARI MORA MA

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	106H00000X	Marriage & Family Therapist	125651	CA

General Provider Information

NPI Number	:	1457184814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARI MORA MA

Provider Business Mailing Address
First Line	:	20911 AVENIDA AMAPOLA
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-2210
Country	:	US
Telephone Number	:	949-463-1796
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 PARK COURT PL STE F200
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-5015
Country	:	US
Telephone Number	:	949-229-5156
Fax Number	:

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

Provider Enumeration Date	:	08/21/2024
Last Update Date	:	08/21/2024

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Directions to “ MARI MORA MA” Practice Location

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