Provider Demographics
NPI:1477244259
Name:MUNOZ CARDOZO, IVONNE JOHANNA (PA)
Entity Type:Individual
Prefix:
First Name:IVONNE
Middle Name:JOHANNA
Last Name:MUNOZ CARDOZO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 TEAGUE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-3773
Mailing Address - Country:US
Mailing Address - Phone:956-616-3675
Mailing Address - Fax:
Practice Address - Street 1:510 TEAGUE AVE APT 1
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-3773
Practice Address - Country:US
Practice Address - Phone:956-616-3675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1656363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant