Healthcare Provider Details

I. General information

NPI: 1104754324
Provider Name (Legal Business Name): NANCY ELIZABETH MUNOZ DE HENRIQUEZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N MACLAY AVE STE 2
SAN FERNANDO CA
91340-2909
US

IV. Provider business mailing address

19156 HAMLIN ST UNIT 2
RESEDA CA
91335-5842
US

V. Phone/Fax

Practice location:
  • Phone: 818-837-1355
  • Fax:
Mailing address:
  • Phone: 818-602-8741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF09240335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: