Provider Demographics
NPI:1184735664
Name:KNIGHT, MYRNA ATALA
Entity type:Individual
Prefix:MRS
First Name:MYRNA
Middle Name:ATALA
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 GRANITE HILLS DR # DRB
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-5300
Mailing Address - Country:US
Mailing Address - Phone:619-997-6457
Mailing Address - Fax:
Practice Address - Street 1:1031 25TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-2102
Practice Address - Country:US
Practice Address - Phone:619-232-6454
Practice Address - Fax:619-235-4607
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76087106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist