Provider Demographics
NPI:1013186956
Name:MUNOZ, MARC A (PA)
Entity type:Individual
Prefix:MR
First Name:MARC
Middle Name:A
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:MARC
Other - Middle Name:A
Other - Last Name:MUNOZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:21030 REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5920
Mailing Address - Country:US
Mailing Address - Phone:510-538-0430
Mailing Address - Fax:510-538-1839
Practice Address - Street 1:21030 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5920
Practice Address - Country:US
Practice Address - Phone:510-538-0430
Practice Address - Fax:510-538-1839
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15018363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical