Healthcare Provider Details

I. General information

NPI: 1174815393
Provider Name (Legal Business Name): ABRAHAM FERNANDO MUNOZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2844 COLOMA ST
PLACERVILLE CA
95667-4406
US

IV. Provider business mailing address

2858 HICKORY LN
PLACERVILLE CA
95667-4327
US

V. Phone/Fax

Practice location:
  • Phone: 530-642-1715
  • Fax: 530-626-8992
Mailing address:
  • Phone: 530-417-0677
  • Fax: 530-621-4560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: