Provider Demographics
NPI:1720972961
Name:MODERN PSYCHIATRY
Entity type:Organization
Organization Name:MODERN PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA MORA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:509-910-4559
Mailing Address - Street 1:1030 N CENTER PKWY STE 113
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7160
Mailing Address - Country:US
Mailing Address - Phone:509-910-4559
Mailing Address - Fax:509-447-7455
Practice Address - Street 1:1030 N CENTER PKWY STE 113
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7160
Practice Address - Country:US
Practice Address - Phone:509-910-4559
Practice Address - Fax:509-447-7455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty