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NPI Code Detail

MEDICARE: BERNARDO JOVEN MORA MD

MEDICARE: BERNARDO JOVEN MORA MD
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
12084P0800XPsychiatry PhysicianA52412CA
22084P0804XChild & Adolescent Psychiatry PhysicianA52412CA

General Provider Information

NPI Number : 1790868834
Entity Type Code : Individual
Provider Name (Legal Business Name) : BERNARDO JOVEN MORA MD
Provider Business Mailing Address
First Line : 3801 YOSEMITE BLVD # E-331
Second Line :
City : MODESTO
State : CA
Zip : 95357-0529
Country : US
Telephone Number : 209-525-6119
Fax Number :
Provider Business Practice Location Address
First Line : 421 E MORRIS AVE
Second Line :
City : MODESTO
State : CA
Zip : 95354-0437
Country : US
Telephone Number : 209-558-7494
Fax Number : 209-558-8918
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2006
Last Update Date : 01/08/2019

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