Provider Demographics
NPI:1962003335
Name:MUNOZ VALBUENA, JAINER JOSE (SA-C)
Entity Type:Individual
Prefix:
First Name:JAINER
Middle Name:JOSE
Last Name:MUNOZ VALBUENA
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14861 S MARBLE ROCK WAY
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-2266
Mailing Address - Country:US
Mailing Address - Phone:407-607-1473
Mailing Address - Fax:
Practice Address - Street 1:14861 S MARBLE ROCK WAY
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-2266
Practice Address - Country:US
Practice Address - Phone:407-607-1473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT20-436246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant