Derek Craig Mori, PA-C
Physician Assistant in Santa Cruz, CA. Individual provider (NPI-1).
NPI number1164093969
StatusActive
Last updated in NPPESMar 6, 2024
Details
- NPI
- 1164093969
- Entity type
- Individual (NPI-1)
- Name
- Derek Craig Mori
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 2, 2021
- Certification date
- Mar 6, 2024
- Last updated
- Mar 6, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | PA59688 | CA | Yes |
| 363A00000X | Physician Assistant | – | – |
Practice location
2980 El Rancho DrSanta Cruz, CA 95060-1103
Phone 831-438-1430
Mailing address
325 Distel CirLos Altos, CA 94022-1408
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