Healthcare Provider Details

I. General information

NPI: 1427846245
Provider Name (Legal Business Name): GEOVANI MUNOZ M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 N SOUTHSIDE PLAZA ST
RICHMOND VA
23224-1742
US

IV. Provider business mailing address

808 W FRANKLIN ST DEPT OF
RICHMOND VA
23284-9031
US

V. Phone/Fax

Practice location:
  • Phone: 804-230-7777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: