Healthcare Provider Details

I. General information

NPI: 1356045181
Provider Name (Legal Business Name): IAN TILER MOSIER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 11/27/2025
Certification Date: 11/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3124 INTERNATIONAL BLVD
OAKLAND CA
94601-2902
US

IV. Provider business mailing address

50 W MANOR DR UNIT 1358
PACIFICA CA
94044-8811
US

V. Phone/Fax

Practice location:
  • Phone: 510-535-4400
  • Fax:
Mailing address:
  • Phone: 415-212-8790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: