Provider Demographics
NPI:1619599933
Name:MUNIZ, MARISSA CHRISTINE (MFT 130957)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:CHRISTINE
Last Name:MUNIZ
Suffix:
Gender:F
Credentials:MFT 130957
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601331
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92160-1331
Mailing Address - Country:US
Mailing Address - Phone:619-790-3158
Mailing Address - Fax:
Practice Address - Street 1:8600 LA MESA BLVD STE B
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-9572
Practice Address - Country:US
Practice Address - Phone:619-790-3158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA130957106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist