MEDICARE: MS. VASANTHA MUNOZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YS0200X	School Counselor	4036915	AZ

General Provider Information

NPI Number	:	1134451339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VASANTHA MUNOZ

Provider Business Mailing Address
First Line	:	1004 HANCOCK RD
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-5946
Country	:	US
Telephone Number	:	928-758-3961
Fax Number	:

Provider Business Practice Location Address
First Line	:	1004 HANCOCK RD
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-5946
Country	:	US
Telephone Number	:	928-758-3961
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2010
Last Update Date	:	02/12/2010

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