=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508265067
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATHAN ROBERT MOON MA, PSYD, ABPP.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2014
-----------------------------------------------------
Last Update Date | 11/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | NAVAL HEALTH CLINIC HAWAII, 480 CENTRAL AVENUE
-----------------------------------------------------
City | JPBHH
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-496-3365
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | NAVAL HEALTH CLINIC HAWAII 480 CENTRAL AVENUE
-----------------------------------------------------
City | PEARL HARBOR
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-496-3365
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 1328
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY1328
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------