Healthcare Provider Details

I. General information

NPI: 1801538285
Provider Name (Legal Business Name): KAREN ALEXA MUNOZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20040 N 19TH AVE STE D
PHOENIX AZ
85027-4255
US

IV. Provider business mailing address

701 W RIO SALADO PKWY APT 1023
TEMPE AZ
85281-3739
US

V. Phone/Fax

Practice location:
  • Phone: 623-233-1050
  • Fax:
Mailing address:
  • Phone: 956-500-7813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8726
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: