Active NPI
Isabella Xilonen Mora
- Licensed Psychiatric Technician
- Stockton, CA
National Provider Identifier
1710569678
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Psychiatric Technician
- License
- 41854
- Practice address
- 8626 Lower Sac Rd
Stockton, CA 95210-1835 - Phone
- (209) 478-2487
- NPI assigned
- Apr 21, 2021
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Licensed Psychiatric Technician | 167G00000X | 41854 | CA | Primary |
Addresses
Primary practice location
8626 Lower Sac Rd
Stockton, CA 95210-1835
Mailing address
6493 Brook Hollow Cir
Stockton, CA 95219-2436
Phone (209) 938-9234
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 |
|---|---|---|---|
| 41854 | CA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618963200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618963200000",
"number": "1710569678",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6493 BROOK HOLLOW CIR",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952192436",
"telephone_number": "209-938-9234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8626 LOWER SAC RD",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952101835",
"telephone_number": "209-478-2487"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORA",
"first_name": "ISABELLA",
"middle_name": "XILONEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-21",
"last_updated": "2021-04-21",
"certification_date": "2021-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "167G00000X",
"taxonomy_group": "",
"desc": "Licensed Psychiatric Technician",
"state": "CA",
"license": "41854",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.