Provider Demographics
NPI:1194131144
Name:GAY MOSS, STEPHANIE ANNE GABRIELLE (MA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANNE GABRIELLE
Last Name:GAY MOSS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 DURANT AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1725
Mailing Address - Country:US
Mailing Address - Phone:888-813-9786
Mailing Address - Fax:
Practice Address - Street 1:2728 DURANT AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1725
Practice Address - Country:US
Practice Address - Phone:888-813-9786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program