Provider Demographics
NPI:1902207665
Name:MORED, MYRA
Entity Type:Individual
Prefix:MRS
First Name:MYRA
Middle Name:
Last Name:MORED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7767 EARLSTON CT
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-2405
Mailing Address - Country:US
Mailing Address - Phone:916-747-8438
Mailing Address - Fax:
Practice Address - Street 1:3870 ROSIN CT STE 130
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1647
Practice Address - Country:US
Practice Address - Phone:916-363-1553
Practice Address - Fax:916-363-1638
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program