=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184635872
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MUNA GOYAL M.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2006
-----------------------------------------------------
Last Update Date | 10/18/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14100 FIVAY RD SUITE 120
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34667-7180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-819-2338
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14100 FIVAY ROAD SUITE 120
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34667
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-819-2338
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME80052
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------