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General NPI Number Information
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NPI Number | 1780856286
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Entity Type | Individual
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Provider Name | MAHA MICHELLE KABBAN-MOSES PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/25/2008
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Last Update Date | 03/19/2020
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Provider Practice Location Address
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Address Line | 1224 10TH ST STE 201A
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City | CORONADO
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State | CA
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Zip | 92118-3420
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Country | US
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Telephone | 619-770-7192
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Fax | 619-393-1770
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Provider Business Mailing Address
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Address Line | 6816 CIBOLA RD
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City | SAN DIEGO
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State | CA
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Zip | 92120-1707
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Country | US
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Telephone | 619-770-7192
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Fax | 619-393-1770
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY21837
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PSY 21837
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY 21837
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License Number State | CA
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