Healthcare Provider Details

I. General information

NPI: 1053860692
Provider Name (Legal Business Name): TIA GABRIELA RILL MOSCARELLO MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR
STANFORD CA
94305-2200
US

IV. Provider business mailing address

341 ARKANSAS ST
SAN FRANCISCO CA
94107-2812
US

V. Phone/Fax

Practice location:
  • Phone: 650-862-7762
  • Fax:
Mailing address:
  • Phone: 650-862-7762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC000783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: