1225216443 NPI number — MR. RUFINO RAYMOND MORA LCSW

Table of content: MR. RUFINO RAYMOND MORA LCSW (NPI 1225216443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225216443 NPI number — MR. RUFINO RAYMOND MORA LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORA
Provider First Name:
RUFINO
Provider Middle Name:
RAYMOND
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225216443
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 THE CITY DR S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92868-3205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-635-2614
Provider Business Mailing Address Fax Number:
949-635-2650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 THE CITY DR S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868-3205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-635-2614
Provider Business Practice Location Address Fax Number:
949-635-2650
Provider Enumeration Date:
02/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS879 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LCS879 . This is a "STATE BOARD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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