Provider Demographics
NPI:1457350100
Name:MUNIZ, JESUS
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:
Last Name:MUNIZ
Suffix:
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:PO BOX 3406
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-3406
Mailing Address - Country:US
Mailing Address - Phone:787-778-1711
Mailing Address - Fax:787-790-5246
Practice Address - Street 1:73 CALLE SANTA CRUZ
Practice Address - Street 2:SUITE 410
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6910
Practice Address - Country:US
Practice Address - Phone:787-778-1711
Practice Address - Fax:787-790-5246
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8599174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist