Healthcare Provider Details

I. General information

NPI: 1487742854
Provider Name (Legal Business Name): CATHERINE MOLLER RN-CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 4TH AVE
SAN DIEGO CA
92103-2116
US

IV. Provider business mailing address

FILE 54433
LOS ANGELES CA
90074-0001
US

V. Phone/Fax

Practice location:
  • Phone: 858-626-5672
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number523644
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number523644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: