=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699834671
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA ROBLES MUNOZ MFT TRAINEE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 123 W GUTIERREZ ST
-----------------------------------------------------
City | SANTA BARBARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93101-3424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-965-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 360 ELLWOOD BEACH DR. APARTMENT #7
-----------------------------------------------------
City | GOLETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-968-2127
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------