Provider Demographics
NPI:1790285930
Name:GAN & MUNIZ ENTERPRISES, LLC
Entity Type:Organization
Organization Name:GAN & MUNIZ ENTERPRISES, LLC
Other - Org Name:KETAMINE INFUSION CLINIC OF EL PASO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNIZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:CRNA, APRN
Authorized Official - Phone:915-740-0067
Mailing Address - Street 1:1201 E SCHUSTER AVE
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902
Mailing Address - Country:US
Mailing Address - Phone:915-740-0067
Mailing Address - Fax:
Practice Address - Street 1:1201 E SCHUSTER AVE
Practice Address - Street 2:SUITE 4A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902
Practice Address - Country:US
Practice Address - Phone:915-740-0067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GAN &MUNIZ ENTERPRISES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8120207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty