Basic Information
| Provider Information | |||||||||
| NPI: | 1245365113 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURGA | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | DANIEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MFTI 42287 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 748 N ORCUTT DR | ||||||||
| Address2: | |||||||||
| City: | MONTEBELLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906402713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238871983 | ||||||||
| FaxNumber: | 3238871983 | ||||||||
| Practice Location | |||||||||
| Address1: | 1160 S GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | GLENDORA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917405000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263355980 | ||||||||
| FaxNumber: | 6263355989 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2007 | ||||||||
| LastUpdateDate: | 02/04/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | 58450 | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 106H00000X | 58450 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YM0800X | IMF58450 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.