Healthcare Provider Details

I. General information

NPI: 1346321866
Provider Name (Legal Business Name): GLORIA M MUNOZ P.H.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 ST. T-3 NO.6 URB LAS LOMAS
SAN JUAN PR
00921
US

IV. Provider business mailing address

PO BOX 1451
GUAYNABO PR
00970-1451
US

V. Phone/Fax

Practice location:
  • Phone: 787-783-4368
  • Fax: 787-781-1539
Mailing address:
  • Phone: 787-453-9804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number2708
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: