Provider Demographics
NPI:1346297702
Name:MORA, OLGA Y (NP)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:Y
Last Name:MORA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 WEST LOOP SOUTH
Mailing Address - Street 2:STE 400B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027
Mailing Address - Country:US
Mailing Address - Phone:281-444-1738
Mailing Address - Fax:281-444-3084
Practice Address - Street 1:3450 FM 1960 W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068
Practice Address - Country:US
Practice Address - Phone:281-444-1738
Practice Address - Fax:281-444-3084
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX439453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L17846Medicare PIN