Healthcare Provider Details

I. General information

NPI: 1245365113
Provider Name (Legal Business Name): JOSE DANIEL MURGA MFTI 42287
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 S GRAND AVE
GLENDORA CA
91740-5000
US

IV. Provider business mailing address

748 N ORCUTT DR
MONTEBELLO CA
90640-2713
US

V. Phone/Fax

Practice location:
  • Phone: 626-335-5980
  • Fax: 626-335-5989
Mailing address:
  • Phone: 323-887-1983
  • Fax: 323-887-1983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number58450
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number58450
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMF58450
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: