Provider Demographics
NPI:1871858159
Name:MUTO, JOSEPH DOMINICK (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DOMINICK
Last Name:MUTO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 RANCHO RD
Mailing Address - Street 2:
Mailing Address - City:ADELANTO
Mailing Address - State:CA
Mailing Address - Zip Code:92301-2237
Mailing Address - Country:US
Mailing Address - Phone:760-561-6100
Mailing Address - Fax:
Practice Address - Street 1:10400 RANCHO RD
Practice Address - Street 2:
Practice Address - City:ADELANTO
Practice Address - State:CA
Practice Address - Zip Code:92301-2237
Practice Address - Country:US
Practice Address - Phone:760-561-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2013-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist