Provider Demographics
NPI:1093414195
Name:MUNIZICH, JOSEPH STEVEN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:STEVEN
Last Name:MUNIZICH
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 S MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4456
Mailing Address - Country:US
Mailing Address - Phone:323-803-8589
Mailing Address - Fax:
Practice Address - Street 1:646 S MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4456
Practice Address - Country:US
Practice Address - Phone:323-803-8589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024141363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner