=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386863934
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSALIA MUNOZ-LEDO KOBA M.F.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30101 TOWN CENTER DR STE 109
-----------------------------------------------------
City | LAGUNA NIGUEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92677-5028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-294-4413
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30101 TOWN CENTER DR STE 109
-----------------------------------------------------
City | LAGUNA NIGUEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92677-5028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-294-4413
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFCC 22304
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------