Provider Demographics
NPI:1730244229
Name:FUNES, IRMA ADILIA (MA)
Entity type:Individual
Prefix:
First Name:IRMA
Middle Name:ADILIA
Last Name:FUNES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 MOSCOW ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-2807
Mailing Address - Country:US
Mailing Address - Phone:415-469-7265
Mailing Address - Fax:415-239-1712
Practice Address - Street 1:539 MOSCOW ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-2807
Practice Address - Country:US
Practice Address - Phone:415-469-7265
Practice Address - Fax:415-239-1712
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT29522106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist