Healthcare Provider Details

I. General information

NPI: 1770953820
Provider Name (Legal Business Name): MRS. MARITZA MUNIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 MAITLAND CENTER COMMONS BLVD STE 212
MAITLAND FL
32751-7270
US

IV. Provider business mailing address

180 RONNIE DR
ALTAMONTE SPRINGS FL
32714-3230
US

V. Phone/Fax

Practice location:
  • Phone: 407-636-3530
  • Fax:
Mailing address:
  • Phone: 407-860-6236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH13665
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: