Provider Demographics
NPI:1821701384
Name:MORA, RICARDO (SURGICAL ASSISTANT)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:MORA
Suffix:
Gender:M
Credentials:SURGICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 BIRD SONG ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-5138
Mailing Address - Country:US
Mailing Address - Phone:915-873-5244
Mailing Address - Fax:
Practice Address - Street 1:2317 BIRD SONG ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-5138
Practice Address - Country:US
Practice Address - Phone:915-873-5244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant