Provider Demographics
NPI:1063299717
Name:MORA, JUSTIN (FNP)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:MORA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2271 S DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-1216
Mailing Address - Country:US
Mailing Address - Phone:805-922-0561
Mailing Address - Fax:805-922-0083
Practice Address - Street 1:2271 S DEPOT ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1216
Practice Address - Country:US
Practice Address - Phone:805-922-0561
Practice Address - Fax:805-922-0083
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily