Provider Demographics
NPI:1336317718
Name:MUNOZ, MARIE DOROTHY (LVN)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:DOROTHY
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 340
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3531
Mailing Address - Country:US
Mailing Address - Phone:619-278-0016
Mailing Address - Fax:877-777-3597
Practice Address - Street 1:1011 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 340
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3531
Practice Address - Country:US
Practice Address - Phone:619-278-0016
Practice Address - Fax:877-777-3597
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA218289164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse