Healthcare Provider Details

I. General information

NPI: 1063728053
Provider Name (Legal Business Name): BEAU MUNOZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 KNIGHT LANE BLDG H ATTN: MEDICAL STAFF SERVICES MEDICINE SUPPORT COMMAND
JACKSONVILLE FL
32212-0140
US

IV. Provider business mailing address

25003 PEACHLAND AVE UNIT 112
NEWHALL CA
91321-2525
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-8038
  • Fax:
Mailing address:
  • Phone: 661-310-4629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number26409
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number26409
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number26409
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: