Provider Demographics
NPI:1669749719
Name:MURRIETA, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MURRIETA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HARBOR BLVD
Mailing Address - Street 2:BUILDING E
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-4047
Mailing Address - Country:US
Mailing Address - Phone:650-802-5191
Mailing Address - Fax:
Practice Address - Street 1:400 HARBOR BLVD
Practice Address - Street 2:BUILDING E
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-4047
Practice Address - Country:US
Practice Address - Phone:650-802-5191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool