Provider Demographics
NPI:1972814408
Name:MORA, MICHELLE MARIA (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MARIA
Last Name:MORA
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:4016 STEPPING STONE CT
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-6389
Mailing Address - Country:US
Mailing Address - Phone:707-225-1330
Mailing Address - Fax:
Practice Address - Street 1:4016 STEPPING STONE CT
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-6389
Practice Address - Country:US
Practice Address - Phone:615-346-8182
Practice Address - Fax:615-829-8970
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2024-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ74992084N0400X
NH188112084N0400X
NMA-2164-182084N0400X
CT620732084N0400X
IL036.1454942084N0400X
AK1142102084N0400X
ARE-100732084N0400X
ALDO.178142084N0400X
MI51010189132084N0400X
KS05-406902084N0400X
IN02005024A2084N0400X
GA767562084N0400X
TXR68472084N0400X
LA3083242084N0400X
CA20A148402084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology