Provider Demographics
NPI:1316302904
Name:DE LA MORA, AMANDA (PCCI)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:DE LA MORA
Suffix:
Gender:F
Credentials:PCCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 N GRAPE ST
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3079
Mailing Address - Country:US
Mailing Address - Phone:760-975-9939
Mailing Address - Fax:
Practice Address - Street 1:490 N GRAPE ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3079
Practice Address - Country:US
Practice Address - Phone:760-975-9939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCCI1975101YP2500X
CAAPCC9754101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional