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General NPI Number Information
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NPI Number | 1417314733
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Entity Type | Organization
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Legal Business Name | DORIS A MUCHIRAHODO
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Dates
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Enumeration Date | 01/16/2016
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Last Update Date | 01/16/2016
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Provider Practice Location Address
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Address Line | 182 VIA SERENA
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City | RSM
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State | CA
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Zip | 92688-1728
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Country | US
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Telephone | 949-813-5222
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Fax |
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Provider Business Mailing Address
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Address Line | 182 VIA SERENA
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City | RSM
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State | CA
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Zip | 92688-1728
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Country | US
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Telephone | 949-813-5222
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Fax |
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Authorized Official
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Title or Position | MARRIAGE & FAMILY THERAPIST INTERN
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Name | DORIS A MUCHIRAHONDO
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Credential | MA
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Telephone | 949-813-5222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 90294
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License Number State | CA
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