Provider Demographics
NPI:1033808456
Name:MORA, GABRIEL ANTONIO
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ANTONIO
Last Name:MORA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5240 SW 94TH AVE
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-4118
Mailing Address - Country:US
Mailing Address - Phone:305-709-7839
Mailing Address - Fax:
Practice Address - Street 1:1435 W 49TH PL STE 305
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3147
Practice Address - Country:US
Practice Address - Phone:305-557-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11026061363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner