Healthcare Provider Details

I. General information

NPI: 1578371639
Provider Name (Legal Business Name): MELIZA BRIDGET MACIEL MUNOZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14315 CORPORATE WAY STE B
MORENO VALLEY CA
92553-9048
US

IV. Provider business mailing address

14315 CORPORATE WAY STE B
MORENO VALLEY CA
92553-9048
US

V. Phone/Fax

Practice location:
  • Phone: 619-891-6385
  • Fax:
Mailing address:
  • Phone: 619-891-6385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number374700402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: