Healthcare Provider Details

I. General information

NPI: 1407470966
Provider Name (Legal Business Name): ANDREA MUNCADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5922 EL CAJON BLVD
SAN DIEGO CA
92115-3826
US

IV. Provider business mailing address

5922 EL CAJON BLVD
SAN DIEGO CA
92115-3826
US

V. Phone/Fax

Practice location:
  • Phone: 619-583-1542
  • Fax:
Mailing address:
  • Phone: 619-583-1542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License Number11382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: