Provider Demographics
NPI:1790519668
Name:MOCHA, MARK HENRY (CPSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:HENRY
Last Name:MOCHA
Suffix:
Gender:M
Credentials:CPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 CORTEZ AVE
Mailing Address - Street 2:
Mailing Address - City:HURLEY
Mailing Address - State:NM
Mailing Address - Zip Code:88043-9746
Mailing Address - Country:US
Mailing Address - Phone:575-284-5538
Mailing Address - Fax:
Practice Address - Street 1:411 CORTEZ AVE
Practice Address - Street 2:
Practice Address - City:HURLEY
Practice Address - State:NM
Practice Address - Zip Code:88043-9746
Practice Address - Country:US
Practice Address - Phone:575-284-5538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-31
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator