Provider Demographics
NPI:1780856286
Name:KABBAN-MOSES, MAHA MICHELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAHA
Middle Name:MICHELLE
Last Name:KABBAN-MOSES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MAHA
Other - Middle Name:
Other - Last Name:MOSES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:6816 CIBOLA RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-1707
Mailing Address - Country:US
Mailing Address - Phone:619-770-7192
Mailing Address - Fax:619-393-1770
Practice Address - Street 1:1224 10TH ST STE 201A
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-3420
Practice Address - Country:US
Practice Address - Phone:619-770-7192
Practice Address - Fax:619-393-1770
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21837103TC0700X
CAPSY 21837251S00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY21837OtherBOARD OF PSYCHOLOGY
000OtherNONE PRESENTLY