Provider Demographics
NPI:1184846040
Name:MUCHNICK, RON (MFT PHD)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:
Last Name:MUCHNICK
Suffix:
Gender:M
Credentials:MFT PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12395 EL CAMINO REAL
Mailing Address - Street 2:305
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130
Mailing Address - Country:US
Mailing Address - Phone:858-847-0448
Mailing Address - Fax:858-523-1037
Practice Address - Street 1:12395 EL CAMINO REAL
Practice Address - Street 2:305
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130
Practice Address - Country:US
Practice Address - Phone:858-847-0448
Practice Address - Fax:858-523-1037
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44037106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist