Healthcare Provider Details

I. General information

NPI: 1073446001
Provider Name (Legal Business Name): TRAVIS DEAN MOSES JR. RADT-1
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 23RD ST
RICHMOND CA
94804-1830
US

IV. Provider business mailing address

208 23RD ST
RICHMOND CA
94804-1830
US

V. Phone/Fax

Practice location:
  • Phone: 510-216-4601
  • Fax:
Mailing address:
  • Phone: 510-216-4601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1428360126
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: