Provider Demographics
NPI:1992248546
Name:SOZA, MOSES ROBERT SR (CADC-CAS)
Entity type:Individual
Prefix:MR
First Name:MOSES
Middle Name:ROBERT
Last Name:SOZA
Suffix:SR
Gender:M
Credentials:CADC-CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 N 1ST ST STE 135
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-6818
Mailing Address - Country:US
Mailing Address - Phone:559-225-1464
Mailing Address - Fax:559-225-1693
Practice Address - Street 1:3636 N 1ST ST STE 135&154
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-6800
Practice Address - Country:US
Practice Address - Phone:559-225-1464
Practice Address - Fax:559-225-1693
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC17501214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)