Provider Demographics
NPI:1417102351
Name:MOOSA, RAINA (PSYD)
Entity Type:Individual
Prefix:
First Name:RAINA
Middle Name:
Last Name:MOOSA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 DEEP VALLEY DR UNIT 3773
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES PENINSULA
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3125
Mailing Address - Country:US
Mailing Address - Phone:310-845-6335
Mailing Address - Fax:
Practice Address - Street 1:955 DEEP VALLEY DR UNIT 3773
Practice Address - Street 2:
Practice Address - City:PALOS VERDES PENINSULA
Practice Address - State:CA
Practice Address - Zip Code:90274-3125
Practice Address - Country:US
Practice Address - Phone:310-845-6335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist