Provider Demographics
NPI:1457465999
Name:MUNGER, ANGELICA CARRANZA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:CARRANZA
Last Name:MUNGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANGELICA
Other - Middle Name:
Other - Last Name:CARRANZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8010 S COUNTY ROAD 5
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80528-9002
Mailing Address - Country:US
Mailing Address - Phone:970-377-1300
Mailing Address - Fax:970-377-1314
Practice Address - Street 1:8010 S COUNTY ROAD 5
Practice Address - Street 2:SUITE 101
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80528-9002
Practice Address - Country:US
Practice Address - Phone:970-377-1300
Practice Address - Fax:970-377-1314
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40122225400000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COH61993Medicare UPIN