Provider Demographics
NPI:1215188362
Name:MOSER, JODI LYNN (PSYD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:LYNN
Last Name:MOSER
Suffix:
Gender:F
Credentials:PSYD, ABPP
Other - Prefix:DR
Other - First Name:JODI
Other - Middle Name:LYNN
Other - Last Name:CEBALLOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:140 SYLVESTER RD BLDG 500
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-3521
Mailing Address - Country:US
Mailing Address - Phone:619-553-0448
Mailing Address - Fax:
Practice Address - Street 1:140 SYLVESTER RD BLDG 500
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-3521
Practice Address - Country:US
Practice Address - Phone:619-553-0448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26623103TC0700X
TX34985103TC0700X
RIPS01091103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB140482Medicare UPIN
TX286660001Medicaid