Provider Demographics
NPI:1083156434
Name:MUNOZ, JOSE DE JESUS JR
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:DE JESUS
Last Name:MUNOZ
Suffix:JR
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 1:10537 ABBOTTFORD WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-5803
Mailing Address - Country:US
Mailing Address - Phone:916-396-9703
Mailing Address - Fax:
Practice Address - Street 1:4801 34TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-4849
Practice Address - Country:US
Practice Address - Phone:916-737-9202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No171M00000XOther Service ProvidersCase Manager/Care Coordinator