Healthcare Provider Details

I. General information

NPI: 1649315052
Provider Name (Legal Business Name): GEORGETA MUNTEAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GEORGETA MUNTEAN MD

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 6TH AVE
SAN DIEGO CA
92103-5933
US

IV. Provider business mailing address

2950 6TH AVE
SAN DIEGO CA
92103-5933
US

V. Phone/Fax

Practice location:
  • Phone: 619-296-2618
  • Fax: 619-296-2619
Mailing address:
  • Phone: 619-296-2618
  • Fax: 619-296-2619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA39319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: