Provider Demographics
NPI:1649445396
Name:DEJESUS MUNOZ, SAYRA
Entity type:Individual
Prefix:DR
First Name:SAYRA
Middle Name:
Last Name:DEJESUS MUNOZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. LAS BRISAS 123
Mailing Address - Street 2:CALLE 3
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-479-7079
Mailing Address - Fax:787-817-2571
Practice Address - Street 1:URB. LAS BRISAS 123
Practice Address - Street 2:CALLE 3
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-479-7079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17118208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR17118OtherMEDICAL LICENCE