Provider Demographics
NPI:1992699029
Name:MUNOZ, JESSICA MICHELLE (PPS)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:MICHELLE
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 LIZZIE ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3062
Mailing Address - Country:US
Mailing Address - Phone:805-549-1200
Mailing Address - Fax:
Practice Address - Street 1:1330 9TH ST
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-1350
Practice Address - Country:US
Practice Address - Phone:805-534-2856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool