Provider Demographics
NPI:1821874462
Name:DE LA MORA, MIGUEL ANGEL (DNP, PMHNP)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ANGEL
Last Name:DE LA MORA
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Gender:M
Credentials:DNP, PMHNP
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Mailing Address - Street 1:1030 N CENTER PKWY STE 112
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7160
Mailing Address - Country:US
Mailing Address - Phone:509-910-4559
Mailing Address - Fax:509-447-7455
Practice Address - Street 1:1550 S PIONEER WAY STE 165
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-4637
Practice Address - Country:US
Practice Address - Phone:509-793-9780
Practice Address - Fax:509-764-3246
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2024-04-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAAP61485710363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health