Healthcare Provider Details

I. General information

NPI: 1215563390
Provider Name (Legal Business Name): STEPHANIE MUNOZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8222 S 48TH ST STE 200
PHOENIX AZ
85044-5303
US

IV. Provider business mailing address

8148 HESS AVE
LA GRANGE IL
60525-5272
US

V. Phone/Fax

Practice location:
  • Phone: 623-300-5477
  • Fax:
Mailing address:
  • Phone: 708-977-0723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9109
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number9109
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.007788
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: