Healthcare Provider Details

I. General information

NPI: 1740834795
Provider Name (Legal Business Name): ROSA E MUNOZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 SIERRA DR SE STE 2
ALBUQUERQUE NM
87108-5633
US

IV. Provider business mailing address

301 UNSER BLVD NW
ALBUQUERQUE NM
87121-1927
US

V. Phone/Fax

Practice location:
  • Phone: 575-737-8717
  • Fax:
Mailing address:
  • Phone: 505-925-4126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1565
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: