Provider Demographics
NPI:1568450153
Name:MORA, ELAINE (PEDIATRICIAN)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:
Last Name:MORA
Suffix:
Gender:F
Credentials:PEDIATRICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5075
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-9809
Mailing Address - Country:US
Mailing Address - Phone:787-804-1025
Mailing Address - Fax:787-804-1025
Practice Address - Street 1:40B CALLE QUILINCHINI
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-1906
Practice Address - Country:US
Practice Address - Phone:787-804-1025
Practice Address - Fax:787-804-1025
Is Sole Proprietor?:No
Enumeration Date:2005-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12116208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics