Healthcare Provider Details

I. General information

NPI: 1609900125
Provider Name (Legal Business Name): ROBERT W. MOFFIE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13100 VALLEYHEART DR 301
STUDIO CITY CA
91604-1959
US

IV. Provider business mailing address

13100 VALLEYHEART DR 301
STUDIO CITY CA
91604-1959
US

V. Phone/Fax

Practice location:
  • Phone: 818-501-6844
  • Fax: 818-783-9254
Mailing address:
  • Phone: 818-501-6844
  • Fax: 818-783-9254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY12704
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1874
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: