Healthcare Provider Details

I. General information

NPI: 1801046628
Provider Name (Legal Business Name): ELISA MUNOZ NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 W 3RD ST FL 4
LOS ANGELES CA
90017-1408
US

IV. Provider business mailing address

1230 W 3RD ST FL 4
LOS ANGELES CA
90017-1408
US

V. Phone/Fax

Practice location:
  • Phone: 213-481-2511
  • Fax:
Mailing address:
  • Phone: 213-481-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberC278641
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: