Provider Demographics
NPI:1225763915
Name:MUNOZ, JORGE ADRIAN (SA-C)
Entity Type:Individual
Prefix:
First Name:JORGE ADRIAN
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 W 8TH ST LOT 97
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-2893
Mailing Address - Country:US
Mailing Address - Phone:480-287-4135
Mailing Address - Fax:
Practice Address - Street 1:1640 W 8TH ST LOT 1640W8TH
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-2833
Practice Address - Country:US
Practice Address - Phone:480-287-4135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22-412246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant