Healthcare Provider Details

I. General information

NPI: 1851159891
Provider Name (Legal Business Name): ROSA E MUNOZ PHD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2024
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

PO BOX 45681
RIO RANCHO NM
87174-5681
US

V. Phone/Fax

Practice location:
  • Phone: 575-737-8717
  • Fax: 505-672-7769
Mailing address:
  • Phone: 505-226-1960
  • Fax: 505-672-7769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ROSA E MUNOZ
Title or Position: OWNER
Credential:
Phone: 505-401-6133