Healthcare Provider Details

I. General information

NPI: 1063387074
Provider Name (Legal Business Name): JESSICA MUNOZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S LAKE AVE
PASADENA CA
91101-3005
US

IV. Provider business mailing address

121 W 82ND ST
LOS ANGELES CA
90003-2802
US

V. Phone/Fax

Practice location:
  • Phone: 626-410-0299
  • Fax:
Mailing address:
  • Phone: 626-432-7270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: