Provider Demographics
NPI:1407192149
Name:MURRIETA, ROBERT (CAS II, CSC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:MURRIETA
Suffix:
Gender:M
Credentials:CAS II, CSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N IRWIN ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-3814
Mailing Address - Country:US
Mailing Address - Phone:559-583-9300
Mailing Address - Fax:559-583-9307
Practice Address - Street 1:700 N IRWIN ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3814
Practice Address - Country:US
Practice Address - Phone:559-583-9300
Practice Address - Fax:559-583-9307
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA02-071181101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)