Provider Demographics
NPI:1881456655
Name:MULLER, WYATT EDWIN
Entity type:Individual
Prefix:
First Name:WYATT
Middle Name:EDWIN
Last Name:MULLER
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 1:30122 NIGUEL RD # AOT.127
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5203
Mailing Address - Country:US
Mailing Address - Phone:949-344-6495
Mailing Address - Fax:
Practice Address - Street 1:30122 NIGUEL RD # AOT.127
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-5203
Practice Address - Country:US
Practice Address - Phone:949-344-6495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician