Provider Demographics
NPI:1093979890
Name:MUNIZ, LORENA (MD)
Entity Type:Individual
Prefix:DR
First Name:LORENA
Middle Name:
Last Name:MUNIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 E BUSCH BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-5303
Mailing Address - Country:US
Mailing Address - Phone:813-984-8846
Mailing Address - Fax:813-984-8827
Practice Address - Street 1:5001 E BUSCH BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-5303
Practice Address - Country:US
Practice Address - Phone:813-984-8846
Practice Address - Fax:813-984-8827
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 106966208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics