Healthcare Provider Details

I. General information

NPI: 1932632742
Provider Name (Legal Business Name): HANNAH MARIE MIRASOL MUNIZ CASTRO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47474 WASHINGTON ST
LA QUINTA CA
92253-8846
US

IV. Provider business mailing address

47474 WASHINGTON ST
LA QUINTA CA
92253-8846
US

V. Phone/Fax

Practice location:
  • Phone: 760-469-5213
  • Fax:
Mailing address:
  • Phone: 760-469-5213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA186124
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME149163
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License NumberT5401
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License NumberA186124
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: