Provider Demographics
NPI:1992938203
Name:MORA, MELISSA ROSE (DO)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ROSE
Last Name:MORA
Suffix:
Gender:F
Credentials:DO
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12008 S SHORE BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6395
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8188 S JOG RD STE 205
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-2952
Practice Address - Country:US
Practice Address - Phone:561-231-5200
Practice Address - Fax:561-231-5210
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS11560207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine