MEDICARE: RUBEN JOSE MUNOZ A061931122

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	A061931122	CA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1548774128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUBEN JOSE MUNOZ A061931122

Provider Business Mailing Address
First Line	:	18633 E ARROW HWY
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91722-1846
Country	:	US
Telephone Number	:	626-662-3916
Fax Number	:

Provider Business Practice Location Address
First Line	:	13684 JEREMY CT
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91739-2031
Country	:	US
Telephone Number	:	909-803-0376
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2017
Last Update Date	:	12/09/2025

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