Provider Demographics
NPI:1124826060
Name:MUNGUIA, CECILIA
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:MUNGUIA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 WESTCHESTER AVE STE 3A
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-3600
Mailing Address - Country:US
Mailing Address - Phone:718-523-2269
Mailing Address - Fax:
Practice Address - Street 1:420 WESTCHESTER AVE STE 3A
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-3600
Practice Address - Country:US
Practice Address - Phone:718-523-2269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28MU1562659174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist