Provider Demographics
NPI:1952975666
Name:MUNOZ, GREGORIO PALOMIN
Entity Type:Individual
Prefix:
First Name:GREGORIO
Middle Name:PALOMIN
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GREG
Other - Middle Name:P
Other - Last Name:MUNOZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CERT MEDICAL,SOCIAL
Mailing Address - Street 1:28094 STATE ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:MABTON
Mailing Address - State:WA
Mailing Address - Zip Code:98935-9575
Mailing Address - Country:US
Mailing Address - Phone:509-832-1440
Mailing Address - Fax:509-786-3192
Practice Address - Street 1:100 E 3RD ST
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:WA
Practice Address - Zip Code:98930-1368
Practice Address - Country:US
Practice Address - Phone:509-203-6601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC56003171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter