Provider Demographics
NPI:1598232233
Name:MUNOZ, JORGE
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5214 NW WEST PIPER CIR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2771
Mailing Address - Country:US
Mailing Address - Phone:786-372-3836
Mailing Address - Fax:
Practice Address - Street 1:5214 NW WEST PIPER CIR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2771
Practice Address - Country:US
Practice Address - Phone:786-372-3836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver