Provider Demographics
NPI:1669723300
Name:GAINES-MOSS, ROBYN (MS, RD)
Entity type:Individual
Prefix:MS
First Name:ROBYN
Middle Name:
Last Name:GAINES-MOSS
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3098
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90510-3098
Mailing Address - Country:US
Mailing Address - Phone:310-792-3914
Mailing Address - Fax:855-898-4055
Practice Address - Street 1:4825 TORRANCE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4134
Practice Address - Country:US
Practice Address - Phone:310-542-7900
Practice Address - Fax:855-898-4055
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARD687545133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered