Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY0652 | NV |
Y | 103T00000X | Psychologist | PY0652 | NV |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PY0652 | NV |
NPI | 1013277193 |
---|---|
Provider Name | Dr. Ariana P Mora |
First Address | Las Vegas, NV 89119-3534 |
Second Address | Las Vegas, NV 89119-3534 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2012 |
Last Update Date | 30/05/2012 |