| Lawrence A. Mora Md Inc | |
|
5901 W Olympic Blvd Ste 404 Los Angeles CA 90036-4669 | |
| (323) 456-0185 | |
| (323) 443-1744 |
| Full Name | Lawrence A. Mora Md Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 5901 W Olympic Blvd Ste 404, Los Angeles, California |
| Authorized Official Name and Position | Lawrence A Mora (PRESIDENT) |
| Authorized Official Contact | 3234560185 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lawrence A. Mora Md Inc 5901 W Olympic Blvd Ste 404 Los Angeles CA 90036-4669 Ph: (323) 456-0185 | Lawrence A. Mora Md Inc 5901 W Olympic Blvd Ste 404 Los Angeles CA 90036-4669 Ph: (323) 456-0185 |
| NPI Number | 1912930512 |
|---|---|
| Provider Enumeration Date | 07/08/2006 |
| Last Update Date | 02/24/2021 |
| Medicare PECOS PAC ID | 4789778705 |
|---|---|
| Medicare Enrollment ID | O20070921000381 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912930512 | NPI | - | NPPES |
| 00A713990 | Other | CA | BLUE SHIELD |
| 1912930512 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Lawrence A Mora |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205851615 PECOS PAC ID: 6305820846 Enrollment ID: I20040614001239 |
| Provider Name | Carlos Padilla Villar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396358370 PECOS PAC ID: 6709299142 Enrollment ID: I20210104002191 |
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