Healthcare Provider Details

I. General information

NPI: 1053700047
Provider Name (Legal Business Name): ERINA MUNIZ M.A., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 BLUE OAKS BLVD STE 180
ROSEVILLE CA
95678-7037
US

IV. Provider business mailing address

1328 BLUE OAKS BLVD STE 180
ROSEVILLE CA
95678-7037
US

V. Phone/Fax

Practice location:
  • Phone: 916-676-0488
  • Fax: 916-771-4370
Mailing address:
  • Phone: 916-676-0488
  • Fax: 916-771-4370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-16411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: