Active NPI
Gisela Mora
- Dentist
- El Centro, CA
National Provider Identifier
1982113239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 102061
- Practice address
- 718 Mulberry LN
El Centro, CA 92243-4461 - Phone
- (760) 604-5064
- NPI assigned
- Sep 29, 2017
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 102061 | CA | Primary |
Addresses
Primary practice location
718 Mulberry LN
El Centro, CA 92243-4461
Mailing address
718 Mulberry LN
El Centro, CA 92243-4461
Phone (760) 604-5064
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 102061 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171220000537 | CA | Order and Referring Only - Oral Surgery | 0143588186 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506643200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1506643200000",
"number": "1982113239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "718 MULBERRY LN",
"city": "EL CENTRO",
"state": "CA",
"postal_code": "922434461",
"telephone_number": "760-604-5064"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "718 MULBERRY LN",
"city": "EL CENTRO",
"state": "CA",
"postal_code": "922434461",
"telephone_number": "760-604-5064"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORA",
"first_name": "GISELA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-09-29",
"last_updated": "2017-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "102061",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "102061",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in El Centro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.