Provider Demographics
NPI:1487352605
Name:MORA-QUINTRO, BRIANNA ANAHI
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:ANAHI
Last Name:MORA-QUINTRO
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 1:1517 E CAMPUS DR # 318
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92834-9001
Mailing Address - Country:US
Mailing Address - Phone:760-712-8107
Mailing Address - Fax:
Practice Address - Street 1:1517 E CAMPUS DR # 318
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92834-9001
Practice Address - Country:US
Practice Address - Phone:760-712-8107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA96096412E52228OtherMEDICAL