Provider Demographics
NPI:1023895778
Name:MORA-OZUNA, CHARMAINE JENNIFER
Entity type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:JENNIFER
Last Name:MORA-OZUNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 S MESA HILLS DR APT 2219
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5191
Mailing Address - Country:US
Mailing Address - Phone:404-804-2816
Mailing Address - Fax:
Practice Address - Street 1:800 N MESA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3976
Practice Address - Country:US
Practice Address - Phone:915-215-6770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling