Provider Demographics
NPI:1184104408
Name:MORA, JASON (LVN)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MORA
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 PRIVATE ROAD 900
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-3035
Mailing Address - Country:US
Mailing Address - Phone:512-787-8381
Mailing Address - Fax:
Practice Address - Street 1:401 PRIVATE ROAD 900
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-3035
Practice Address - Country:US
Practice Address - Phone:512-787-8381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX338239164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse