Healthcare Provider Details

I. General information

NPI: 1033925722
Provider Name (Legal Business Name): JUAN MUNIZ FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12586 AVENUE 408
OROSI CA
93647-9454
US

IV. Provider business mailing address

12586 AVENUE 408
OROSI CA
93647-9454
US

V. Phone/Fax

Practice location:
  • Phone: 877-960-3426
  • Fax:
Mailing address:
  • Phone: 877-960-3426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95033076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: