Active NPI
Vidal Luis Mora, L.A.T., A.T.C.
- Athletic Trainer
- Lake Saint Louis, MO
National Provider Identifier
1841643780
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2015023352
- Practice address
- 7140 Welsh Dr
Lake Saint Louis, MO 63367-4870 - Phone
- (636) 288-1928
- NPI assigned
- Jul 15, 2016
- Last updated
- Jul 15, 2016
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2015023352 | MO | Primary |
Addresses
Primary practice location
7140 Welsh Dr
Lake Saint Louis, MO 63367-4870
Mailing address
7140 Welsh Dr
Lake Saint Louis, MO 63367-4870
Phone (636) 288-1928
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 |
|---|---|---|---|
| 2015023352 | MO | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468540800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468540800000",
"number": "1841643780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7140 WELSH DR",
"city": "LAKE SAINT LOUIS",
"state": "MO",
"postal_code": "633674870",
"telephone_number": "636-288-1928"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7140 WELSH DR",
"city": "LAKE SAINT LOUIS",
"state": "MO",
"postal_code": "633674870",
"telephone_number": "636-288-1928"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORA",
"first_name": "VIDAL",
"middle_name": "LUIS",
"credential": "L.A.T., A.T.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-07-15",
"last_updated": "2016-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MO",
"license": "2015023352",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Saint Louis, MO
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- Christopher James Miller, MD
- Missouri Dental Professionals, Richard Straus, D.M.D., P.C. (Lake St. Louis Dental Care)
- Missouri Dental Professionals, Richard Straus, DMD, PC (Brevco Family Dentistry)
- Jaclyn Morris, CPNP-PC
- Danielle E Nash, DC
- Nicole Barker, LPC, LLC
- Veronica Njwaba, DNP, FNP- BC
- NP Johnson Telehealth Wellness Care, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.