Provider Demographics
NPI:1376115295
Name:MUNIZ VERA, ABDIEL (DR)
Entity Type:Individual
Prefix:DR
First Name:ABDIEL
Middle Name:
Last Name:MUNIZ VERA
Suffix:
Gender:M
Credentials:DR
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 1106
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-1106
Mailing Address - Country:US
Mailing Address - Phone:787-546-7508
Mailing Address - Fax:
Practice Address - Street 1:CARR 125 KM 5.5
Practice Address - Street 2:BO VOLADORAS
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-546-7508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7030103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7875467508OtherCELULAR