MEDICARE: RAINA MOOSA PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1417102351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAINA MOOSA PSY.D.

Provider Business Mailing Address
First Line	:	955 DEEP VALLEY DR UNIT 3773
Second Line	:
City	:	PALOS VERDES PENINSULA
State	:	CA
Zip	:	90274-3125
Country	:	US
Telephone Number	:	310-845-6335
Fax Number	:

Provider Business Practice Location Address
First Line	:	955 DEEP VALLEY DR UNIT 3773
Second Line	:
City	:	PALOS VERDES PENINSULA
State	:	CA
Zip	:	90274-3125
Country	:	US
Telephone Number	:	310-845-6335
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2008
Last Update Date	:	12/28/2023

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