Provider Demographics
NPI:1164035770
Name:MUNOZ CONSULTING LLC
Entity Type:Organization
Organization Name:MUNOZ CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-728-6583
Mailing Address - Street 1:PO BOX 1684
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71165-1684
Mailing Address - Country:US
Mailing Address - Phone:318-424-5449
Mailing Address - Fax:855-230-1466
Practice Address - Street 1:4900 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-4521
Practice Address - Country:US
Practice Address - Phone:318-747-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty