Healthcare Provider Details

I. General information

NPI: 1063491694
Provider Name (Legal Business Name): MAGALI MUNIZ-MARIANI D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A3 CALLE LODI URB. LUARCA
SAN JUAN PR
00924-3804
US

IV. Provider business mailing address

A39 CALLE 1 PARQUES DE SAN IGNACIO
SAN JUAN PR
00921-4839
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-2424
  • Fax: 787-296-2424
Mailing address:
  • Phone: 787-764-2424
  • Fax: 787-296-2424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2120
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: