Healthcare Provider Details

I. General information

NPI: 1003575069
Provider Name (Legal Business Name): MR. DENIS VICENTE MUNOZ GUTIERREZ SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2021
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 FOREST HILL BLVD STE 3
LAKE CLARKE SHORES FL
33406-6031
US

IV. Provider business mailing address

316 PONTE VEDRA RD
PALM SPRINGS FL
33461-1821
US

V. Phone/Fax

Practice location:
  • Phone: 561-444-2814
  • Fax: 561-444-2458
Mailing address:
  • Phone: 561-215-2497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: