Healthcare Provider Details

I. General information

NPI: 1568179844
Provider Name (Legal Business Name): DIANA DOMINIQUE MUNOZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 DELA VINA AVE
MONTEREY CA
93940-3974
US

IV. Provider business mailing address

617 BAYONET CIR
MARINA CA
93933-4600
US

V. Phone/Fax

Practice location:
  • Phone: 831-440-7030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: