Basic Information
| Provider Information | |||||||||
| NPI: | 1548418585 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOYER | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3101 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921035802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6199801435 | ||||||||
| FaxNumber: | 6195420332 | ||||||||
| Practice Location | |||||||||
| Address1: | 3101 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921035802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6199801435 | ||||||||
| FaxNumber: | 6195420332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2008 | ||||||||
| LastUpdateDate: | 09/03/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY21503 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.