Healthcare Provider Details

I. General information

NPI: 1821059411
Provider Name (Legal Business Name): JORGE W MUNOZ MARCIAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 CALLE SAN MIGUEL
GUANICA PR
00653-2611
US

IV. Provider business mailing address

PO BOX 744
ENSENADA PR
00647-0744
US

V. Phone/Fax

Practice location:
  • Phone: 787-821-6323
  • Fax: 787-821-0486
Mailing address:
  • Phone: 787-821-6323
  • Fax: 787-821-0486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number07F2273
License Number StatePR

VIII. Authorized Official

Name: MR. JORGE W MUNOZ
Title or Position: OWNER
Credential:
Phone: 787-821-6323