Healthcare Provider Details

I. General information

NPI: 1033603626
Provider Name (Legal Business Name): ADRIANA YATES MUNAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17000 PORTER RD
WINTER GARDEN FL
34787-8915
US

IV. Provider business mailing address

1414 KUHL AVENUE MP38
ORLANDO FL
32891-4701
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-3467
  • Fax:
Mailing address:
  • Phone: 321-842-4713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME149466
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: