Healthcare Provider Details

I. General information

NPI: 1679000509
Provider Name (Legal Business Name): LAURA MUNOZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4352 W WHITEWATER AVE
WESTON FL
33332-2467
US

IV. Provider business mailing address

4352 W WHITEWATER AVE
WESTON FL
33332-2467
US

V. Phone/Fax

Practice location:
  • Phone: 571-435-6166
  • Fax:
Mailing address:
  • Phone: 571-435-6166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number17-306
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: