Provider Demographics
NPI:1801538285
Name:MUNOZ, KAREN ALEXA
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ALEXA
Last Name: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 1:701 W RIO SALADO PKWY APT 1023
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-3739
Mailing Address - Country:US
Mailing Address - Phone:956-500-7813
Mailing Address - Fax:
Practice Address - Street 1:20040 N 19TH AVE STE D
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4255
Practice Address - Country:US
Practice Address - Phone:623-233-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8726363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty