Healthcare Provider Details

I. General information

NPI: 1659803047
Provider Name (Legal Business Name): JOE MUNIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

679 S NEW HAMPSHIRE AVE STE 400
LOS ANGELES CA
90005-1355
US

IV. Provider business mailing address

679 S NEW HAMPSHIRE AVE STE 400
LOS ANGELES CA
90005-1355
US

V. Phone/Fax

Practice location:
  • Phone: 213-639-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: