Provider Demographics
NPI:1154614691
Name:MUNOZ, ANDREA LYNN (LPT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNN
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1675 MORENA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3703
Mailing Address - Country:US
Mailing Address - Phone:619-275-8000
Mailing Address - Fax:619-275-8004
Practice Address - Street 1:1675 MORENA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3703
Practice Address - Country:US
Practice Address - Phone:619-275-8000
Practice Address - Fax:619-275-8004
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT35095167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician