Healthcare Provider Details

I. General information

NPI: 1174242929
Provider Name (Legal Business Name): MATTHEW MUNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CENTERPOINTE DR STE 130
LA PALMA CA
90623-2562
US

IV. Provider business mailing address

20 CENTERPOINTE DR STE 130
LA PALMA CA
90623-2562
US

V. Phone/Fax

Practice location:
  • Phone: 657-325-8313
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number139530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: