Healthcare Provider Details

I. General information

NPI: 1417102351
Provider Name (Legal Business Name): RAINA MOOSA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 12/28/2023
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 DEEP VALLEY DR UNIT 3773
PALOS VERDES PENINSULA CA
90274-3125
US

IV. Provider business mailing address

955 DEEP VALLEY DR UNIT 3773
PALOS VERDES PENINSULA CA
90274-3125
US

V. Phone/Fax

Practice location:
  • Phone: 310-845-6335
  • Fax:
Mailing address:
  • Phone: 310-845-6335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: