Healthcare Provider Details

I. General information

NPI: 1982380085
Provider Name (Legal Business Name): ANDREA ISABELLE MOYA MUNOZ PLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 N COURT ST
FREDERICK MD
21701-6614
US

IV. Provider business mailing address

220 W WASHINGTON ST APT 1
CHARLES TOWN WV
25414-1544
US

V. Phone/Fax

Practice location:
  • Phone: 301-304-7108
  • Fax:
Mailing address:
  • Phone: 917-371-3601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number825
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: