Healthcare Provider Details

I. General information

NPI: 1912336009
Provider Name (Legal Business Name): RALPH MUNIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8765 AERO DR
SAN DIEGO CA
92123-1781
US

IV. Provider business mailing address

8765 AERO DR
SAN DIEGO CA
92123-1781
US

V. Phone/Fax

Practice location:
  • Phone: 619-207-0396
  • Fax:
Mailing address:
  • Phone: 619-207-0396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: