Healthcare Provider Details

I. General information

NPI: 1013363522
Provider Name (Legal Business Name): THE J. MOSS FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 05/09/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10089 WILLOW CREEK RD STE 200
SAN DIEGO CA
92131-1699
US

IV. Provider business mailing address

10089 WILLOW CREEK RD STE 200
SAN DIEGO CA
92131-1699
US

V. Phone/Fax

Practice location:
  • Phone: 619-793-2010
  • Fax: 858-408-1891
Mailing address:
  • Phone: 619-793-2010
  • Fax: 858-408-1891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MARLAYNA DANIELLE BOLLLINGER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 619-793-2010