Healthcare Provider Details

I. General information

NPI: 1063643138
Provider Name (Legal Business Name): ANGEL OMAR ROMAN MUNOZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17075 CAGAN RIDGE BLVD STE 100
CLERMONT FL
34714-9619
US

IV. Provider business mailing address

PO BOX 878
DAVENPORT FL
33836-0878
US

V. Phone/Fax

Practice location:
  • Phone: 863-588-4775
  • Fax: 863-380-0030
Mailing address:
  • Phone: 689-223-3898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17695
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN747
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: