Healthcare Provider Details

I. General information

NPI: 1558299511
Provider Name (Legal Business Name): JOSE MICHAEL MUNJOZ-FLORES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W FRANKLIN ST
SHELTON WA
98584-3518
US

IV. Provider business mailing address

20027 SAGEWOOD LN SW
CENTRALIA WA
98531-8304
US

V. Phone/Fax

Practice location:
  • Phone: 360-968-0111
  • Fax:
Mailing address:
  • Phone: 360-968-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN00133870
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: