Provider Demographics
NPI:1477912798
Name:MUNEVAR, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MUNEVAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5134
Mailing Address - Country:US
Mailing Address - Phone:760-633-7073
Mailing Address - Fax:
Practice Address - Street 1:435 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5134
Practice Address - Country:US
Practice Address - Phone:760-633-7073
Practice Address - Fax:760-633-6051
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA 260273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit