Healthcare Provider Details

I. General information

NPI: 1053574988
Provider Name (Legal Business Name): JUAN-CARLOS MUNIZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JUAN CARLOS MUNIZ M.D.

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62 AVE AMBULATORY CARE BUILDING - HEART STATION
MIAMI FL
33155-4069
US

IV. Provider business mailing address

3100 SW 62 AVE AMBULATORY CARE BUILDING - HEART STATION
MIAMI FL
33155-4069
US

V. Phone/Fax

Practice location:
  • Phone: 786-624-3694
  • Fax:
Mailing address:
  • Phone: 786-624-3694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberME 102513
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: