Healthcare Provider Details

I. General information

NPI: 1295340388
Provider Name (Legal Business Name): KATHRYN THERESA MOFFA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 10/30/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHOC CHILDREN'S SPECIALISTS 1201 W. LA VETA AVE.
ORANGE CA
92868-4203
US

IV. Provider business mailing address

CHOC CHILDREN'S SPECIALISTS 1201 W. LA VETA AVE.
ORANGE CA
92868-4203
US

V. Phone/Fax

Practice location:
  • Phone: 888-770-2462
  • Fax:
Mailing address:
  • Phone: 888-770-2462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number11412
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number34626
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: