Healthcare Provider Details

I. General information

NPI: 1851083539
Provider Name (Legal Business Name): SALVADOR DE LA PENA MUNOZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 GRAND AVE
LONG BEACH CA
90815-1765
US

IV. Provider business mailing address

2525 GRAND AVE
LONG BEACH CA
90815-1765
US

V. Phone/Fax

Practice location:
  • Phone: 562-570-4000
  • Fax:
Mailing address:
  • Phone: 562-570-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number564780
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95262748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: