Provider Demographics
NPI:1275419962
Name:MUNOZ, SANDRA ERSILIA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ERSILIA
Last Name:MUNOZ
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 1:15313 SANTA GERTRUDES AVE # L104
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-5087
Mailing Address - Country:US
Mailing Address - Phone:323-702-7502
Mailing Address - Fax:
Practice Address - Street 1:15313 SANTA GERTRUDES AVE # L104
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-5087
Practice Address - Country:US
Practice Address - Phone:323-702-7502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician