Healthcare Provider Details

I. General information

NPI: 1437134830
Provider Name (Legal Business Name): JOSE L. MUNOZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 W MAIN ST
SOMERTON AZ
85350-6329
US

IV. Provider business mailing address

PO BOX 617
SOMERTON AZ
85350-0617
US

V. Phone/Fax

Practice location:
  • Phone: 928-627-1120
  • Fax: 928-722-6113
Mailing address:
  • Phone: 928-662-0406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20379
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: