Provider Demographics
NPI:1649795824
Name:MORA ZAZUETA, THELMA MELISSA
Entity type:Individual
Prefix:
First Name:THELMA
Middle Name:MELISSA
Last Name:MORA ZAZUETA
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 1:2475 PASEO DE LAS AMERICAS # 3826
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-7255
Mailing Address - Country:US
Mailing Address - Phone:425-577-0130
Mailing Address - Fax:
Practice Address - Street 1:8110 POCKET RD STE 102
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-5829
Practice Address - Country:US
Practice Address - Phone:916-245-0715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health