Provider Demographics
NPI:1265109888
Name:MUNOZ PEDIATRIC AND ADOLESCENT CLINIC
Entity type:Organization
Organization Name:MUNOZ PEDIATRIC AND ADOLESCENT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:469-776-8669
Mailing Address - Street 1:2406 EMMETT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-5415
Mailing Address - Country:US
Mailing Address - Phone:469-776-8669
Mailing Address - Fax:833-357-1698
Practice Address - Street 1:2406 EMMETT ST STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-5415
Practice Address - Country:US
Practice Address - Phone:469-776-8669
Practice Address - Fax:833-357-1698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty