Provider Demographics
NPI:1194019000
Name:MUNIZ, IVIS (MS, BCBA)
Entity Type:Individual
Prefix:MISS
First Name:IVIS
Middle Name:
Last Name:MUNIZ
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10561 SW 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2709
Mailing Address - Country:US
Mailing Address - Phone:786-261-8116
Mailing Address - Fax:
Practice Address - Street 1:10561 SW 27TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2709
Practice Address - Country:US
Practice Address - Phone:786-261-8116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-10-6970103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst