Healthcare Provider Details

I. General information

NPI: 1477790327
Provider Name (Legal Business Name): BEN MUNETA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4824 MCMAHON BLVD NW SUITE 115
ALBUQUERQUE NM
87114-5412
US

IV. Provider business mailing address

3309C JUAN TABO NEBLVD C
ALBUQUERQUE NM
87111-5130
US

V. Phone/Fax

Practice location:
  • Phone: 505-792-2815
  • Fax: 505-792-2812
Mailing address:
  • Phone: 505-508-1654
  • Fax: 505-508-2482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2007-0072
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: