Provider Demographics
NPI:1760712590
Name:MOESSMER, CHRISTOPHER ROBIN
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ROBIN
Last Name:MOESSMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 BREAKWATER CT
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-3611
Mailing Address - Country:US
Mailing Address - Phone:510-671-0031
Mailing Address - Fax:510-200-7393
Practice Address - Street 1:3530 BREAKWATER CT
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-3611
Practice Address - Country:US
Practice Address - Phone:510-363-8992
Practice Address - Fax:650-525-1155
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2020-05-12
Deactivation Date:2020-05-01
Deactivation Code:
Reactivation Date:2020-05-12
Provider Licenses
StateLicense IDTaxonomies
CA11 0001024B343900000X
CA20453416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)