Provider Demographics
NPI:1790835726
Name:MUNOZ, JULIAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:C
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MISS
Other - First Name:DRIALYS
Other - Middle Name:
Other - Last Name:MUNOZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13356 NW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2729
Mailing Address - Country:US
Mailing Address - Phone:954-322-3880
Mailing Address - Fax:954-961-9992
Practice Address - Street 1:750 E 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1966
Practice Address - Country:US
Practice Address - Phone:305-688-5770
Practice Address - Fax:305-688-5687
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68118208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37817040100Medicaid
FLG13885Medicare UPIN
FL26765TMedicare ID - Type Unspecified