Individual
MR. CHARLES H MORA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
5505 N ATLANTIC AVE, SUITE 106, COCOA BEACH, FL 32931-5111
(321) 917-3329
Mailing address
5505 N ATLANTIC AVE, SUITE 106, COCOA BEACH, FL 32931-5111
(321) 917-3329
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA7779
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA7779
STATE LICENSE NUMBER
FL
Enumeration date
02/07/2009
Last updated
02/07/2009
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