Provider Demographics
NPI:1073090551
Name:MUNOZ, ESMERALDA (LVN)
Entity Type:Individual
Prefix:
First Name:ESMERALDA
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 E GUERRERO ST APT 2
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-6514
Mailing Address - Country:US
Mailing Address - Phone:956-480-3863
Mailing Address - Fax:
Practice Address - Street 1:712 E GUERRERO ST APT 2
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-6514
Practice Address - Country:US
Practice Address - Phone:956-480-3863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX303432164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1790847531Medicaid