Individual
MR. KEVIN PATRICIO MORA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
111 S GRANT AVE, COLUMBUS, OH 43215-4701
(614) 566-9000
Mailing address
831 WACKEMAN CT, WESTERVILLE, OH 43081-3779
(614) 940-1048
Taxonomy
Speciality
Code
Description
License number
State
261QV0200X
VA Clinic/Center
—
—
363A00000X
Physician Assistant
Primary
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
08/08/2018
Last updated
02/11/2025
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