Provider Demographics
NPI:1841428398
Name:MUNIZ, GINO MIGUEL (MA)
Entity Type:Individual
Prefix:
First Name:GINO
Middle Name:MIGUEL
Last Name:MUNIZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE ELISA TAVAREZ
Mailing Address - Street 2:HB-19
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-479-7879
Mailing Address - Fax:
Practice Address - Street 1:CALLE ELISA TAVAREZ
Practice Address - Street 2:HB-19
Practice Address - City:LEVITTOWN
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-479-7879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3388103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling