Provider Demographics
NPI:1174187025
Name:LOPEZ-MORA, LAURA ANGELICA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANGELICA
Last Name:LOPEZ-MORA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 G ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-2133
Mailing Address - Country:US
Mailing Address - Phone:209-722-0202
Mailing Address - Fax:209-385-9921
Practice Address - Street 1:2841 G ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-2133
Practice Address - Country:US
Practice Address - Phone:209-722-0202
Practice Address - Fax:209-385-9921
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No171M00000XOther Service ProvidersCase Manager/Care Coordinator