Provider Demographics
NPI:1508105297
Name:MUNOZ, JESSICA SANCHEZ (MA, MFTI)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:SANCHEZ
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:MA, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10221 COMPTON AVE
Mailing Address - Street 2:SUITE 104 & 203
Mailing Address - City:WATTS
Mailing Address - State:CA
Mailing Address - Zip Code:90002-2802
Mailing Address - Country:US
Mailing Address - Phone:310-783-4677
Mailing Address - Fax:323-566-1638
Practice Address - Street 1:10221 COMPTON AVE
Practice Address - Street 2:SUITE 104 & 203
Practice Address - City:WATTS
Practice Address - State:CA
Practice Address - Zip Code:90002-2802
Practice Address - Country:US
Practice Address - Phone:310-783-4677
Practice Address - Fax:323-566-1638
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFI79630106H00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist