Healthcare Provider Details

I. General information

NPI: 1568380129
Provider Name (Legal Business Name): DAVID MOSS RADT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 PENNSYLVANIA ST
VALLEJO CA
94590-6933
US

IV. Provider business mailing address

701 POPE DR APT A
VALLEJO CA
94591-6749
US

V. Phone/Fax

Practice location:
  • Phone: 707-643-2715
  • Fax:
Mailing address:
  • Phone: 717-216-1531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1439310426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: