Healthcare Provider Details

I. General information

NPI: 1285832741
Provider Name (Legal Business Name): JORGE FERNANDO MUNOZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 CALLE ROSARIO COND. EL ROSARIO 306
SAN JUAN PR
00912-3113
US

IV. Provider business mailing address

256 CALLE ROSARIO COND. EL ROSARIO 306
SAN JUAN PR
00912
US

V. Phone/Fax

Practice location:
  • Phone: 214-794-6509
  • Fax:
Mailing address:
  • Phone: 214-794-6509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17645
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number17645
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number17645
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: