Provider Demographics
NPI:1780283143
Name:MOCORRO, IGOR GRUNA (DNP, MPH, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:IGOR
Middle Name:GRUNA
Last Name:MOCORRO
Suffix:
Gender:M
Credentials:DNP, MPH, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 DOLPHIN CT
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-2945
Mailing Address - Country:US
Mailing Address - Phone:415-818-5654
Mailing Address - Fax:
Practice Address - Street 1:375 LAGUNA HONDA BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1499
Practice Address - Country:US
Practice Address - Phone:415-699-2402
Practice Address - Fax:415-682-5668
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-17
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA765153163W00000X
CA95015593363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse