Provider Demographics
NPI:1679200067
Name:MUNIZ ESPANA, MARIA FERNANDA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:FERNANDA
Last Name:MUNIZ ESPANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:MUNIZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3118 CASTLEBURY DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1853
Mailing Address - Country:US
Mailing Address - Phone:703-867-6337
Mailing Address - Fax:
Practice Address - Street 1:3118 CASTLEBURY DR
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1853
Practice Address - Country:US
Practice Address - Phone:703-867-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAA64274812172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver