Healthcare Provider Details

I. General information

NPI: 1134174675
Provider Name (Legal Business Name): GRISSEL MUNOZ VARGAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 AVE BORINQUEN
SAN JUAN PR
00915-3822
US

IV. Provider business mailing address

1654 CALLE SANTA ANGELA URB. SAGRADO CORAZON
SAN JUAN PR
00926-4111
US

V. Phone/Fax

Practice location:
  • Phone: 787-268-4171
  • Fax: 787-727-3695
Mailing address:
  • Phone: 787-761-1719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11513
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: