Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 43334 | CA |
NPI | 1003276601 |
---|---|
Provider Name | Alexandra Elizabeth Mora |
First Address | Encinitas, CA 92024-1452 |
Second Address | Santa Ana, CA 92701-4599 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2016 |
Last Update Date | 25/02/2016 |