Healthcare Provider Details

I. General information

NPI: 1669729778
Provider Name (Legal Business Name): MORIAH MOLLING R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 SPRING ST
SAUSALITO CA
94965-1728
US

IV. Provider business mailing address

720 SPRING ST
SAUSALITO CA
94965-1728
US

V. Phone/Fax

Practice location:
  • Phone: 707-362-2581
  • Fax:
Mailing address:
  • Phone: 707-362-2581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1021013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: