Provider Demographics
NPI:1710170964
Name:MOFFITT, ROBERT S (BS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:S
Last Name:MOFFITT
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2117
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-0823
Mailing Address - Country:US
Mailing Address - Phone:951-488-8036
Mailing Address - Fax:
Practice Address - Street 1:6355 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3163
Practice Address - Country:US
Practice Address - Phone:951-369-0219
Practice Address - Fax:951-686-1029
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor