Basic Information
| Provider Information | |||||||||
| NPI: | 1356955355 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MUNOZ | ||||||||
| FirstName: | DIANA | ||||||||
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| Credential: | MA, MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4146 32ND ST APT 3 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921042088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233508857 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4309 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921031407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6198764502 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2020 | ||||||||
| LastUpdateDate: | 09/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 120179 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.