Provider Demographics
NPI:1417919804
Name:MUNIZ, AVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:AVID
Middle Name:J
Last Name:MUNIZ
Suffix:
Gender:M
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:PO BOX 19405
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1405
Mailing Address - Country:US
Mailing Address - Phone:787-726-7008
Mailing Address - Fax:787-726-7083
Practice Address - Street 1:CALLE MANUEL PAVIA
Practice Address - Street 2:PAVIA MEDICAL PLAZA 611 SUITE 214
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-726-7008
Practice Address - Fax:787-726-7083
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9327207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE71424Medicare UPIN
PR0081619Medicare ID - Type Unspecified
PR0082222BMedicare ID - Type Unspecified