Provider Demographics
NPI:1023658259
Name:MUNOZ, HECTOR EDUARDO JR
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:EDUARDO
Last Name:MUNOZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24409 DOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-1814
Mailing Address - Country:US
Mailing Address - Phone:310-720-0294
Mailing Address - Fax:
Practice Address - Street 1:24409 DOBLE AVE
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-1814
Practice Address - Country:US
Practice Address - Phone:310-720-0294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN691435164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse