Provider Demographics
NPI:1386488211
Name:MUNOZ, NADINE YANITSHA
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:YANITSHA
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 LINDA WAY APT D
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6200
Mailing Address - Country:US
Mailing Address - Phone:909-582-0042
Mailing Address - Fax:
Practice Address - Street 1:77711 FLORA RD STE 327
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-4103
Practice Address - Country:US
Practice Address - Phone:909-582-0042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician