Healthcare Provider Details

I. General information

NPI: 1770709198
Provider Name (Legal Business Name): RAFAEL MUNOZ JR. MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3665 KEARNY VILLA RD STE. 405
SAN DIEGO CA
92123-1953
US

IV. Provider business mailing address

3020 CHILDRENS WAY MC 5134
SAN DIEGO CA
92123-4223
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-5990
  • Fax: 858-966-7508
Mailing address:
  • Phone: 858-966-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: