Provider Demographics
NPI:1972957090
Name:MUNOZ MEJIA, JULIETA MARIA (MBBS)
Entity Type:Individual
Prefix:
First Name:JULIETA
Middle Name:MARIA
Last Name:MUNOZ MEJIA
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 STATE ST APT 2917
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3630
Mailing Address - Country:US
Mailing Address - Phone:773-677-5957
Mailing Address - Fax:
Practice Address - Street 1:GRIFFIN HOSPITAL
Practice Address - Street 2:130 DIVISION ST
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1326
Practice Address - Country:US
Practice Address - Phone:773-677-5957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT63942207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program