Provider Demographics
NPI:1093766651
Name:MORA, MARTA L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTA
Middle Name:L
Last Name:MORA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARTHA
Other - Middle Name:LILIANA
Other - Last Name:MORA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:625 S FAIR OAKS AVE
Mailing Address - Street 2:SUITE 235
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2664
Mailing Address - Country:US
Mailing Address - Phone:626-796-7006
Mailing Address - Fax:626-796-9990
Practice Address - Street 1:625 S FAIR OAKS AVE
Practice Address - Street 2:SUITE 235
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2664
Practice Address - Country:US
Practice Address - Phone:626-796-7006
Practice Address - Fax:626-796-9990
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60290207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA60290BOtherRENDERING PIN
CAWA60290COtherRENDERING PIN
CAG39484Medicare UPIN