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General NPI Number Information
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NPI Number | 1316303803
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Entity Type | Individual
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Provider Name | RYAN MOELLER
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Gender | Male
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Dates
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Enumeration Date | 01/13/2016
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Last Update Date | 03/10/2016
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Provider Practice Location Address
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Address Line | 290 IOOF AVE
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City | GILROY
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State | CA
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Zip | 95020-5204
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Country | US
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Telephone | 408-846-2408
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Fax |
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Provider Business Mailing Address
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Address Line | 15113 YOSEMITE WAY
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City | MORGAN HILL
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State | CA
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Zip | 95037-6037
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Country | US
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Telephone | 408-710-7124
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMF91385
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License Number State | CA
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