Healthcare Provider Details

I. General information

NPI: 1871129205
Provider Name (Legal Business Name): STEVEN MUNOZ LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARQUETTE AVE NW STE 1200
ALBUQUERQUE NM
87102-5312
US

IV. Provider business mailing address

1103 PAMPAS PL SE
ALBUQUERQUE NM
87108-4424
US

V. Phone/Fax

Practice location:
  • Phone: 505-429-5750
  • Fax: 505-212-0447
Mailing address:
  • Phone: 505-263-2567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL06686
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: