Provider Demographics
NPI:1982703898
Name:DE LA MORA, OSCAR MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:MANUEL
Last Name:DE LA MORA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 GATEWAY CENTER WAY STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-4545
Mailing Address - Country:US
Mailing Address - Phone:619-264-3107
Mailing Address - Fax:
Practice Address - Street 1:995 GATEWAY CENTER WAY STE 202
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-4545
Practice Address - Country:US
Practice Address - Phone:619-264-3107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA507691208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A507691Medicaid