Healthcare Provider Details

I. General information

NPI: 1295361731
Provider Name (Legal Business Name): KENNETH ALLEN MUNOZ-PORTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 E ALOSTA AVE # 342
AZUSA CA
91702-2740
US

IV. Provider business mailing address

1171 E ALOSTA AVE # 342
AZUSA CA
91702-2740
US

V. Phone/Fax

Practice location:
  • Phone: 626-802-7699
  • Fax: 626-542-1079
Mailing address:
  • Phone: 626-802-7699
  • Fax: 626-542-1079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246Y00000X
TaxonomyHealth Information Specialist/Technologist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: