Provider Demographics
NPI:1720747819
Name:MOSS, CARLA (NBC-HWC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 ADDISON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1165
Mailing Address - Country:US
Mailing Address - Phone:510-380-6101
Mailing Address - Fax:
Practice Address - Street 1:2001 ADDISON ST STE 300
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1165
Practice Address - Country:US
Practice Address - Phone:510-380-6101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-3493047