Provider Demographics
NPI:1922285477
Name:MORA, EVELIN S
Entity Type:Individual
Prefix:
First Name:EVELIN
Middle Name:S
Last Name:MORA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EVELIN
Other - Middle Name:S
Other - Last Name:MORA RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12700 ELLIOTT AVE SPC 486
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-4154
Mailing Address - Country:US
Mailing Address - Phone:626-242-3375
Mailing Address - Fax:
Practice Address - Street 1:118 S OAK KNOLL AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2611
Practice Address - Country:US
Practice Address - Phone:626-795-6907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner