Healthcare Provider Details

I. General information

NPI: 1255766879
Provider Name (Legal Business Name): MAIRA PAULINA MUNOZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 STEWART AVE APT 2
FREEDOM CA
95019-3146
US

IV. Provider business mailing address

2716 FREEDOM BLVD
WATSONVILLE CA
95076-1027
US

V. Phone/Fax

Practice location:
  • Phone: 831-359-6136
  • Fax: 831-476-0345
Mailing address:
  • Phone: 831-688-6293
  • Fax: 831-761-9987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: