Provider Demographics
NPI:1659136752
Name:MUNOZ, JESUS MOISES (PA-C)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:MOISES
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:JESUS
Other - Middle Name:MOISES
Other - Last Name:MUNOZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:220 SEEBERT PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1421
Mailing Address - Country:US
Mailing Address - Phone:219-455-8690
Mailing Address - Fax:
Practice Address - Street 1:220 SEEBERT PL
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1421
Practice Address - Country:US
Practice Address - Phone:219-455-8690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant