Healthcare Provider Details

I. General information

NPI: 1275954323
Provider Name (Legal Business Name): ANGELINA MOXEY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2013
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 RUSTIN AVE
RIVERSIDE CA
92507-2498
US

IV. Provider business mailing address

PO BOX 661
RIALTO CA
92377-0661
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-7320
  • Fax:
Mailing address:
  • Phone: 909-276-7475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number94986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: