Healthcare Provider Details

I. General information

NPI: 1730388240
Provider Name (Legal Business Name): DR. KAILI ANN MOYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date: 10/24/2012
Reactivation Date: 04/27/2016

III. Provider practice location address

2500 ALHAMBRA AVE
MARTINEZ CA
94553-3156
US

IV. Provider business mailing address

2500 ALHAMBRA AVE
MARTINEZ CA
94553-3156
US

V. Phone/Fax

Practice location:
  • Phone: 925-370-5000
  • Fax:
Mailing address:
  • Phone: 925-370-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY27601
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: