Healthcare Provider Details

I. General information

NPI: 1154249993
Provider Name (Legal Business Name): SAM MUNOZ
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 W FOOTHILL BLVD STE 250
UPLAND CA
91786-3786
US

IV. Provider business mailing address

1126 W FOOTHILL BLVD STE 250
UPLAND CA
91786-3786
US

V. Phone/Fax

Practice location:
  • Phone: 951-542-1144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: