Healthcare Provider Details

I. General information

NPI: 1285250258
Provider Name (Legal Business Name): RHIANNA MOON RAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RHIANNA MOON RAY - FIELDS

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 12/13/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 WILLOW PASS RD
CONCORD CA
94520-7930
US

IV. Provider business mailing address

1910 MEREDITH CT
CONCORD CA
94521-1636
US

V. Phone/Fax

Practice location:
  • Phone: 925-407-5873
  • Fax:
Mailing address:
  • Phone: 925-407-5873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: