Provider Demographics
NPI:1376722470
Name:MUNIZ, ELISA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISA
Middle Name:
Last Name:MUNIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10115 HEDGEWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-7309
Mailing Address - Country:US
Mailing Address - Phone:480-282-7081
Mailing Address - Fax:
Practice Address - Street 1:BAYLOR UNIVERSITY MEDICAL CENTER
Practice Address - Street 2:3500 GASTON AVE
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2017
Practice Address - Country:US
Practice Address - Phone:214-361-2152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37690207V00000X
TXQ2028207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ272397Medicaid
AZZ127833Medicare Oscar/Certification