Provider Demographics
NPI:1932291713
Name:MUNOZ, CARMELA (EIS PROFESSIONAL)
Entity Type:Individual
Prefix:MS
First Name:CARMELA
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:EIS PROFESSIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17615 SW 97TH AVE
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5636
Mailing Address - Country:US
Mailing Address - Phone:786-268-2611
Mailing Address - Fax:
Practice Address - Street 1:17615 SW 97TH AVE
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5636
Practice Address - Country:US
Practice Address - Phone:786-268-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL763414500Medicaid
FL811784500Medicaid