Provider Demographics
NPI:1720158728
Name:MUNOZ, NORELLA ESTHER (MD)
Entity Type:Individual
Prefix:MS
First Name:NORELLA
Middle Name:ESTHER
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 SW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-4211
Mailing Address - Country:US
Mailing Address - Phone:785-272-2120
Mailing Address - Fax:
Practice Address - Street 1:1324 SW WESTERN AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-2938
Practice Address - Country:US
Practice Address - Phone:785-233-5885
Practice Address - Fax:785-233-1342
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-23404324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSBMO399914OtherDEA REGISTRATION
KSC70272Medicare UPIN