Provider Demographics
NPI:1962986273
Name:MUNHOZ, JACOB (MA, AMFT)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:MUNHOZ
Suffix:
Gender:M
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 WABASH AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-3964
Mailing Address - Country:US
Mailing Address - Phone:510-912-0086
Mailing Address - Fax:
Practice Address - Street 1:3333 CAMINO DEL RIO S STE 215
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3837
Practice Address - Country:US
Practice Address - Phone:858-848-9883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109499106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA109499OtherBBS REGISTERED ASSOCIATE MARRIAGE AND FAMILY THERAPIST