Healthcare Provider Details

I. General information

NPI: 1881241362
Provider Name (Legal Business Name): MYCAL MOXLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 COLLEGE AVENUE SUITE 240
OAKLAND CA
94618
US

IV. Provider business mailing address

268 BUSH ST STE 3039
SAN FRANCISCO CA
94104-3503
US

V. Phone/Fax

Practice location:
  • Phone: 888-362-3970
  • Fax:
Mailing address:
  • Phone: 888-362-3970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: