Provider Demographics
NPI:1679825053
Name:MUNOZ-GENTRY, EVITA
Entity Type:Individual
Prefix:MRS
First Name:EVITA
Middle Name:
Last Name:MUNOZ-GENTRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 BROADWAY AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-4996
Mailing Address - Country:US
Mailing Address - Phone:831-392-1500
Mailing Address - Fax:831-392-1501
Practice Address - Street 1:1069 BROADWAY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-4996
Practice Address - Country:US
Practice Address - Phone:831-392-1500
Practice Address - Fax:831-392-1501
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program