Healthcare Provider Details

I. General information

NPI: 1821240359
Provider Name (Legal Business Name): SERGIO MUNOZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 S STAPLES ST STE 203
CORPUS CHRISTI TX
78404-3157
US

IV. Provider business mailing address

1001 N CONWAY AVE
MISSION TX
78572-4110
US

V. Phone/Fax

Practice location:
  • Phone: 361-887-9000
  • Fax:
Mailing address:
  • Phone: 956-519-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number011499
License Number StateTX

VIII. Authorized Official

Name: MARLA MUNOZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 956-519-1000