Healthcare Provider Details

I. General information

NPI: 1467059725
Provider Name (Legal Business Name): NICHOLAS HOWARD MUNOZ SUDCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BIRMINGHAM DR STE 240A
CARDIFF CA
92007-1757
US

IV. Provider business mailing address

120 BIRMINGHAM DR STE 240A
CARDIFF CA
92007-1757
US

V. Phone/Fax

Practice location:
  • Phone: 858-208-0121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: