| Doctor Name: | CYRUS A MOAZAM |
| NPI Number: | 1558574814 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | PSY13748 |
| Business Practice Address: | 9267 Greenback Ln B-98 Orangevale, CA - 956624863 |
| Business Phone Number: | 9165059151 |
| Business Fax Number: | 9169887864 |
| Mailing Address: | 767 Heritage Pl, FOLSOM |
| State: | CA |
| Postal Code: | 956306242 |
| Phone Number: | 9165059151 |
| Fax Number: | 9169887864 |
| NPI Enumeration Date: | 05/07/2007 |
| NPI Last Update Date: | 04/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TA0400X |
| License Number: | PSY13748 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |