Healthcare Provider Details

I. General information

NPI: 1265171771
Provider Name (Legal Business Name): HECTOR ALEXIS MUNOZ-MIRO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. SABANA GARDENS 16-15 CALLE 21
CAROLINA PR
00983-2920
US

IV. Provider business mailing address

URB. SABANA GARDENS 16-15 CALLE 21
CAROLINA PR
00983-2920
US

V. Phone/Fax

Practice location:
  • Phone: 787-215-5293
  • Fax:
Mailing address:
  • Phone: 787-215-5293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number24907
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number24907
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: