Provider Demographics
NPI:1003953894
Name:MORA, ROBERT ROCHA (BA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ROCHA
Last Name:MORA
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 E CARTWRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93725-9385
Mailing Address - Country:US
Mailing Address - Phone:559-498-7100
Mailing Address - Fax:559-498-7111
Practice Address - Street 1:3103 E CARTWRIGHT AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93725-9385
Practice Address - Country:US
Practice Address - Phone:559-498-7100
Practice Address - Fax:559-498-7111
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1669559878OtherMEDICAL