Healthcare Provider Details

I. General information

NPI: 1114130713
Provider Name (Legal Business Name): CHARLES E. MOORE RASI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 23RD ST
RICHMOND CA
94804-1338
US

IV. Provider business mailing address

398 S 34TH ST
RICHMOND CA
94804-3120
US

V. Phone/Fax

Practice location:
  • Phone: 510-229-5000
  • Fax: 510-235-3112
Mailing address:
  • Phone: 510-237-8073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRI-M0501060833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: