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NPI Code Detail

MEDICARE: SUSAN MORA

MEDICARE:   SUSAN  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
1171M00000XCase Manager/Care Coordinator
2172V00000XCommunity Health Worker
3175T00000XPeer SpecialistMPSS-CESPLVCA

General Provider Information

NPI Number : 1942630702
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN MORA
Provider Business Mailing Address
First Line : 1216 W AVENUE J
Second Line :
City : LANCASTER
State : CA
Zip : 93534-2944
Country : US
Telephone Number : 661-341-3495
Fax Number :
Provider Business Practice Location Address
First Line : 1216 W AVENUE J
Second Line :
City : LANCASTER
State : CA
Zip : 93534-2944
Country : US
Telephone Number : 661-341-3495
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2013
Last Update Date : 06/26/2023

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Directions to “ SUSAN MORA ” Practice Location

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