Provider Demographics
NPI:1396509220
Name:MORA MIND
Entity type:Organization
Organization Name:MORA MIND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKOGOSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-935-4552
Mailing Address - Street 1:6128 STRAND LOOP SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-9600
Mailing Address - Country:US
Mailing Address - Phone:702-935-4552
Mailing Address - Fax:
Practice Address - Street 1:3291 E WARM SPRINGS RD STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3184
Practice Address - Country:US
Practice Address - Phone:702-935-4552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty