Provider Demographics
NPI:1740202761
Name:MUNIR, DARCENE MELAAC (MD)
Entity type:Individual
Prefix:
First Name:DARCENE
Middle Name:MELAAC
Last Name:MUNIR
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:PO BOX 5486
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-5486
Mailing Address - Country:US
Mailing Address - Phone:818-550-0900
Mailing Address - Fax:303-953-8260
Practice Address - Street 1:5176 HILL RD E
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-6300
Practice Address - Country:US
Practice Address - Phone:818-550-0900
Practice Address - Fax:303-953-8260
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80885207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G808850Medicaid
CA00G808850Medicaid
CAEJ187WMedicare PIN
CAEJ187ZMedicare PIN
CAEJ187AMedicare PIN
G65815Medicare UPIN