Active NPI
Luis Roberto Mora, RD
- Registered Dietitian
- Los Angeles, CA
National Provider Identifier
1487020681
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86003373
- Practice address
- 5807 Avalon Blvd
Los Angeles, CA 90011-5303 - Phone
- (323) 233-2452
- NPI assigned
- Aug 11, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86003373 | CA | Primary |
Addresses
Primary practice location
5807 Avalon Blvd
Los Angeles, CA 90011-5303
Mailing address
10207 San Anselmo Ave
South Gate, CA 90280-5624
Phone (323) 360-4050
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86003373 | CA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594339200000",
"number": "1487020681",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10207 SAN ANSELMO AVE",
"city": "SOUTH GATE",
"state": "CA",
"postal_code": "902805624",
"telephone_number": "323-360-4050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5807 AVALON BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900115303",
"telephone_number": "323-233-2452"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORA",
"first_name": "LUIS",
"middle_name": "ROBERTO",
"name_prefix": "Mr.",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-08-11",
"last_updated": "2020-07-10",
"certification_date": "2020-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "86003373",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.