Individual
DR. PAULA RENEE MORA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1482
(505) 722-1629
Mailing address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1482
(505) 722-1629
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
29216
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21657025
—
NM
01
—
769614
AHCCCS
NM
Enumeration date
03/09/2006
Last updated
02/04/2014
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