Basic Information
| Provider Information | |||||||||
| NPI: | 1053796672 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORA | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | ASW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SALGADO | ||||||||
| OtherFirstName: | JESSICA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3147 MALABAR ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900634018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233833239 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 327 S K ST | ||||||||
| Address2: | |||||||||
| City: | TULARE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932745416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596882043 | ||||||||
| FaxNumber: | 5596881304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2015 | ||||||||
| LastUpdateDate: | 08/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 68419 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.