Provider Demographics
NPI:1205379294
Name:MORA, CARLA LIZETTE (RN, CPNP-PC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:LIZETTE
Last Name:MORA
Suffix:
Gender:F
Credentials:RN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 GUS RALLIS
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932
Mailing Address - Country:US
Mailing Address - Phone:915-242-0339
Mailing Address - Fax:915-242-0343
Practice Address - Street 1:4659 COHEN AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-4429
Practice Address - Country:US
Practice Address - Phone:915-577-0444
Practice Address - Fax:915-577-0509
Is Sole Proprietor?:No
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX760961363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics