Healthcare Provider Details

I. General information

NPI: 1831838457
Provider Name (Legal Business Name): MR. RENE MUNOZ RUBALCAVA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5362 LEMEE LN
MARIPOSA CA
95338-9556
US

IV. Provider business mailing address

PO BOX 99
MARIPOSA CA
95338-0099
US

V. Phone/Fax

Practice location:
  • Phone: 209-966-2000
  • Fax:
Mailing address:
  • Phone: 209-742-0942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number147073
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: