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Individual

MELISSA MARY DE LA MORA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN

Contact information

Practice address
6501 COYLE AVE, CARMICHAEL, CA 95608
(916) 537-5000
Mailing address
6501 COYLE AVE, CARMICHAEL, CA 95608-0306
(916) 537-5000

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
20747
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1730493859
CA
Enumeration date
07/30/2010
Last updated
04/13/2020
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