Provider Demographics
NPI:1356388276
Name:MUNOZ REGIMBAL AND ASSOCIATES PHYSICIANS PROFESSIONAL LLC
Entity type:Organization
Organization Name:MUNOZ REGIMBAL AND ASSOCIATES PHYSICIANS PROFESSIONAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:WINN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHAMBEAU-MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:253-272-5198
Mailing Address - Street 1:316 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:SUITE 304
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4252
Mailing Address - Country:US
Mailing Address - Phone:253-272-5076
Mailing Address - Fax:253-882-1080
Practice Address - Street 1:316 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:SUITE 304
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4252
Practice Address - Country:US
Practice Address - Phone:253-272-5076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAFX00056258174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7088800Medicaid
WAAB02936Medicare PIN