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General NPI Number Information
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NPI Number | 1659553436
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Entity Type | Individual
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Provider Name | DAVID MOLL NMD
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Gender | Male
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Dates
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Enumeration Date | 12/03/2007
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Last Update Date | 12/03/2007
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Provider Practice Location Address
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Address Line | 85 BROOKWOOD AVE SUITE 22
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City | SANTA ROSA
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State | CA
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Zip | 95404-4513
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Country | US
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Telephone | 707-573-1680
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Fax |
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Provider Business Mailing Address
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Address Line | 85 BROOKWOOD AVE SUITE 22
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City | SANTA ROSA
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State | CA
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Zip | 95404-4513
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Country | US
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Telephone |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 42162
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License Number State | CA
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