Provider Demographics
NPI:1851530349
Name:MUNOZ-GUDIEL, IRENE MERCEDES
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:MERCEDES
Last Name:MUNOZ-GUDIEL
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 1:734 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-5418
Mailing Address - Country:US
Mailing Address - Phone:609-396-7241
Mailing Address - Fax:609-396-7241
Practice Address - Street 1:734 W STATE ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-5418
Practice Address - Country:US
Practice Address - Phone:609-396-7241
Practice Address - Fax:609-396-7241
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ09062000224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant