Provider Demographics
NPI:1861463952
Name:MORA, RALPH BAUDILIO (PHD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:BAUDILIO
Last Name:MORA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1-3-24 YAMATE MACHI
Mailing Address - Street 2:
Mailing Address - City:IWAKUNI SHI
Mailing Address - State:YAMAGUCHI
Mailing Address - Zip Code:7400022
Mailing Address - Country:JP
Mailing Address - Phone:810804-556-0125
Mailing Address - Fax:
Practice Address - Street 1:1-3-24 YAMATE MACHI
Practice Address - Street 2:
Practice Address - City:IWAKUNI SHI
Practice Address - State:YAMAGUCHI
Practice Address - Zip Code:7400022
Practice Address - Country:JP
Practice Address - Phone:810804-556-0125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-28
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014242-1103TC0700X, 103T00000X
PAPS017765103T00000X
FLPY3838103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical