Healthcare Provider Details

I. General information

NPI: 1326753070
Provider Name (Legal Business Name): MR. JOSE M. MUNIZ III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 NW 63RD ST
OKLAHOMA CITY OK
73116-1921
US

IV. Provider business mailing address

3409 SHUTTER RIDGE DR
YUKON OK
73099-7366
US

V. Phone/Fax

Practice location:
  • Phone: 405-555-5555
  • Fax:
Mailing address:
  • Phone: 650-740-2401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: