Healthcare Provider Details

I. General information

NPI: 1134583743
Provider Name (Legal Business Name): ALEXANDRA MUNOZ ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2016
Last Update Date: 04/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2404 S LOCUST ST
LAS CRUCES NM
88001-5789
US

IV. Provider business mailing address

2404 S LOCUST ST
LAS CRUCES NM
88001-5789
US

V. Phone/Fax

Practice location:
  • Phone: 575-521-4188
  • Fax: 575-521-3668
Mailing address:
  • Phone: 575-521-4188
  • Fax: 575-521-3668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: