Provider Demographics
NPI:1255015319
Name:MUNIZ, ELOISA ROSE (CASE MANAGER)
Entity type:Individual
Prefix:
First Name:ELOISA
Middle Name:ROSE
Last Name:MUNIZ
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:WATROUS
Mailing Address - State:NM
Mailing Address - Zip Code:87753-0216
Mailing Address - Country:US
Mailing Address - Phone:505-652-9303
Mailing Address - Fax:
Practice Address - Street 1:101 LETTON DR
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-4366
Practice Address - Country:US
Practice Address - Phone:575-445-9551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator