Provider Demographics
NPI:1073974408
Name:MUNOZ, JOSE ANTONIO
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANTONIO
Last Name:MUNOZ
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:STREET PLATA, 4, 2B
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:CADIZ
Mailing Address - Zip Code:11003
Mailing Address - Country:ES
Mailing Address - Phone:003462-852-4108
Mailing Address - Fax:
Practice Address - Street 1:AV ANA DE VIYA 21
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:CADIZ
Practice Address - Zip Code:11009
Practice Address - Country:ES
Practice Address - Phone:003495-600-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-13
Last Update Date:2016-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ111109959390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program