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NPI Code Detail

MEDICARE: DR. ROBERT DAVIS MOSBY PH.D

MEDICARE: DR. ROBERT DAVIS MOSBY PH.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
1103TC0700XClinical PsychologistPSY23882CA
2103TP2701XGroup Psychotherapy PsychologistPSY23882CA

General Provider Information

NPI Number : 1750670030
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT DAVIS MOSBY PH.D
Provider Business Mailing Address
First Line : 611 ALTA VISTA DR
Second Line :
City : HEALDSBURG
State : CA
Zip : 95448-4651
Country : US
Telephone Number : 707-431-2468
Fax Number :
Provider Business Practice Location Address
First Line : 1160 N DUTTON AVE STE 230
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-4658
Country : US
Telephone Number : 707-303-3201
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2011
Last Update Date : 04/07/2011

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