Provider Demographics
NPI:1295397594
Name:MUNOZ, LETICIA Q
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:Q
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1693
Mailing Address - Street 2:
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78104-1693
Mailing Address - Country:US
Mailing Address - Phone:361-318-8560
Mailing Address - Fax:
Practice Address - Street 1:2461 HIGHWAY 59 E
Practice Address - Street 2:3408 FM 673
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-7810
Practice Address - Country:US
Practice Address - Phone:361-318-8560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty