MEDICARE: DR. MAHA MICHELLE KABBAN-MOSES 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
1	103TC0700X	Clinical Psychologist	PSY21837	CA
2	251S00000X	Community/Behavioral Health Agency	PSY 21837	CA
3	103T00000X	Psychologist	PSY 21837	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PSY21837	OTHER	CA	BOARD OF PSYCHOLOGY
2	000	OTHER		NONE PRESENTLY

General Provider Information

NPI Number	:	1780856286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAHA MICHELLE KABBAN-MOSES PH.D.

Provider Business Mailing Address
First Line	:	6816 CIBOLA RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-1707
Country	:	US
Telephone Number	:	619-770-7192
Fax Number	:	619-393-1770

Provider Business Practice Location Address
First Line	:	1224 10TH ST STE 201A
Second Line	:
City	:	CORONADO
State	:	CA
Zip	:	92118-3420
Country	:	US
Telephone Number	:	619-770-7192
Fax Number	:	619-393-1770

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

Provider Enumeration Date	:	03/25/2008
Last Update Date	:	03/19/2020

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Directions to “ DR. MAHA MICHELLE KABBAN-MOSES PH.D.” Practice Location

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