Provider Demographics
NPI:1225738875
Name:CARLOS-MORA, ANITZA MARIBEL
Entity Type:Individual
Prefix:
First Name:ANITZA
Middle Name:MARIBEL
Last Name:CARLOS-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 1:49221 GRAPEFRUIT BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-1461
Mailing Address - Country:US
Mailing Address - Phone:760-541-8520
Mailing Address - Fax:
Practice Address - Street 1:49221 GRAPEFRUIT BLVD STE 6
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-1461
Practice Address - Country:US
Practice Address - Phone:760-541-8520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator