Individual
LYDIA MORA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
808 ELMWOOD ST, ORANGE PARK, FL 32065-6266
(917) 589-9733
Mailing address
808 ELMWOOD ST, ORANGE PARK, FL 32065-6266
(917) 589-9733
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
07/03/2017
Last updated
03/13/2023
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