Provider Demographics
NPI:1912680976
Name:MUNOZ, FAVIOLA GRACIELA
Entity Type:Individual
Prefix:
First Name:FAVIOLA
Middle Name:GRACIELA
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 1:1102 N ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-2306
Mailing Address - Country:US
Mailing Address - Phone:909-239-6289
Mailing Address - Fax:
Practice Address - Street 1:1102 N ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-2306
Practice Address - Country:US
Practice Address - Phone:909-239-6289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula