Individual provider Active NPI

Raina Moosa, PSY.D.

  • Psychologist
  • Palos Verdes Peninsula, CA
National Provider Identifier
1417102351
Registry record updated Dec 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Practice address
955 Deep Valley Dr Unit 3773
Palos Verdes Peninsula, CA 90274-3125
Phone
(310) 845-6335
NPI assigned
Nov 19, 2008
Last updated
Dec 28, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X NU Primary

Addresses

Primary practice location

955 Deep Valley Dr Unit 3773
Palos Verdes Peninsula, CA 90274-3125

Mailing address

955 Deep Valley Dr Unit 3773
Palos Verdes Peninsula, CA 90274-3125
Phone (310) 845-6335

Other practice location 1

45445 Portola Ave Ste 1
Palm Desert, CA 92260-4844
Phone (760) 385-3959

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161031001225 CA Practitioner - Clinical Psychologist 5395023022

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
27799CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
The Refinery Integrated Wellness Services Marriage and Family Thera CurrentSince Feb 18, 2021 Accepting new patients
Therapy Wherever You Are, a Psychological Corporation Psychologist CurrentSince Dec 31, 2023 Accepting new patients

Locations

45445 Portola Ave
Ste 1
Palm Desert, CA 92260
Phone (760) 385-3959

955 Deep Valley Dr
Unit 3773
Palos Verdes Peninsula, CA 90274
Phone (310) 845-6335

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1227052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703721600000",
    "number": "1417102351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "955 DEEP VALLEY DR UNIT 3773",
            "city": "PALOS VERDES PENINSULA",
            "state": "CA",
            "postal_code": "902743125",
            "telephone_number": "310-845-6335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 DEEP VALLEY DR UNIT 3773",
            "city": "PALOS VERDES PENINSULA",
            "state": "CA",
            "postal_code": "902743125",
            "telephone_number": "310-845-6335"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "45445 Portola Ave Ste 1",
            "address_purpose": "LOCATION",
            "city": "Palm Desert",
            "state": "CA",
            "postal_code": "922604844",
            "country_code": "US",
            "telephone_number": "760-385-3959",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOOSA",
        "first_name": "RAINA",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-19",
        "last_updated": "2023-12-28",
        "certification_date": "2021-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palos Verdes Peninsula, CA

Sources for this page

Verify at the official NPI Registry.