NPIMap

Organization Active NPI

Clinica Medica de la Mora Inc

  • Internal Medicine Physician
  • San Diego, CA
National Provider Identifier
1649598772
Registry record updated May 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
C50916 Issued in CA
Legal business name
CLINICA MEDICA DE LA MORA INC
Practice address
995 Gateway Center Way
Suite 202
San Diego, CA 92102-4500
Phone
(619) 264-3107
Fax
(619) 264-6927
NPI assigned
May 13, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Oscar Manuel De la Mora, M.D.NPI 1982703898
Title
Owner
Phone
(619) 264-3107

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X C50916 CA Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X A30061 CA
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X A50769 CA

Addresses

Primary practice location

995 Gateway Center Way
Suite 202
San Diego, CA 92102-4500

Mailing address

995 Gateway Center Way
Suite 202
San Diego, CA 92102-4500
Phone (619) 264-3107

Other identifiers 1

IdentifierTypeStateIssuer
A050769MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120319000405 CA Part B Supplier - Clinic/Group Practice 9335279207 Receives reassigned benefits from 3 practitioners
Practice locations: San Diego, CA

National Provider Directory

National Provider Directory
Tax ID family
Clinica Medica de la Mora2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1273708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273708800000",
    "number": "1649598772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "995 GATEWAY CENTER WAY",
            "address_2": "SUITE 202",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921024500",
            "telephone_number": "619-264-3107",
            "fax_number": "619-264-6927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "995 GATEWAY CENTER WAY",
            "address_2": "SUITE 202",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921024500",
            "telephone_number": "619-264-3107",
            "fax_number": "619-264-6927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICA MEDICA DE LA MORA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-13",
        "last_updated": "2010-05-13",
        "status": "A",
        "authorized_official_last_name": "DE LA MORA",
        "authorized_official_first_name": "OSCAR",
        "authorized_official_middle_name": "MANUEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "619-264-3107",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C50916",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A30061",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A50769",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A050769",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.