Provider Demographics
NPI:1457741894
Name:MUNOZ, ANGELO
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:
Last Name:MUNOZ
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 1:2256 W BROADWAY AVE
Mailing Address - Street 2:H119
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804
Mailing Address - Country:US
Mailing Address - Phone:661-742-6185
Mailing Address - Fax:
Practice Address - Street 1:2265 W BROADWAY
Practice Address - Street 2:H119
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-2313
Practice Address - Country:US
Practice Address - Phone:661-742-6185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2550224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant