Provider Demographics
NPI:1992177570
Name:MUNOZ, JUANCARLOS SR
Entity Type:Individual
Prefix:
First Name:JUANCARLOS
Middle Name:
Last Name:MUNOZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:J.C.
Other - Middle Name:
Other - Last Name:MUNOZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRM
Mailing Address - Street 1:254 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-3003
Mailing Address - Country:US
Mailing Address - Phone:503-432-0288
Mailing Address - Fax:
Practice Address - Street 1:254 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-3003
Practice Address - Country:US
Practice Address - Phone:503-432-0288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-CRM-153175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist