Provider Demographics
NPI:1508100462
Name:MUNOZ, DEBORA B (MA, COM)
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:B
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:MA, COM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 PINERIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-4219
Mailing Address - Country:US
Mailing Address - Phone:619-421-7251
Mailing Address - Fax:619-421-6824
Practice Address - Street 1:591 PINERIDGE CT
Practice Address - Street 2:
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-4219
Practice Address - Country:US
Practice Address - Phone:619-421-7251
Practice Address - Fax:619-421-6824
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137-C-06174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA137-C-06OtherINTERNATIONAL ASSOCIATION OF OROFACIAL MYOLOGY