Provider Demographics
NPI:1497026249
Name:MUNOZ, DIANA M (BA)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:M
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MRS
Other - First Name:DIANA
Other - Middle Name:M
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16577 WEST CLYDE MAHER ROAD
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464
Mailing Address - Country:US
Mailing Address - Phone:918-822-3456
Mailing Address - Fax:
Practice Address - Street 1:15481 N JARVIS RD
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-0233
Practice Address - Country:US
Practice Address - Phone:918-822-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services