Healthcare Provider Details

I. General information

NPI: 1730761875
Provider Name (Legal Business Name): JULIANNE MUNOZ REYES RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 S VALLEY DR # 300
LAS CRUCES NM
88005-3132
US

IV. Provider business mailing address

500 OMAR ST APT 106
ANTHONY TX
79821-9366
US

V. Phone/Fax

Practice location:
  • Phone: 575-532-5437
  • Fax:
Mailing address:
  • Phone: 575-520-4961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH5163
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: