Healthcare Provider Details

I. General information

NPI: 1164553525
Provider Name (Legal Business Name): NELIDA MUNOZ MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OFIC. 312 CAROLINA SHOPPING COURT CARR. 3
CAROLINA PR
00985
US

IV. Provider business mailing address

PO BOX 979
CAROLINA PR
00986-0979
US

V. Phone/Fax

Practice location:
  • Phone: 787-757-1040
  • Fax: 787-757-1040
Mailing address:
  • Phone: 787-505-6670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number3868
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: