Basic Information
| Provider Information | |||||||||
| NPI: | 1003953894 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORA | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | ROCHA | ||||||||
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| Credential: | B.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3103 E CARTWRIGHT AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937259385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594987100 | ||||||||
| FaxNumber: | 5594987111 | ||||||||
| Practice Location | |||||||||
| Address1: | 3103 E CARTWRIGHT AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937259385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594987100 | ||||||||
| FaxNumber: | 5594987111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 1669559878 | 01 | CA | MEDICAL | OTHER |