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General NPI Number Information
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NPI Number | 1477790327
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Entity Type | Individual
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Provider Name | BEN MUNETA M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/14/2009
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Last Update Date | 12/30/2015
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Provider Practice Location Address
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Address Line | 4824 MCMAHON BLVD NW SUITE 115
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-5412
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Country | US
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Telephone | 505-792-2815
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Fax | 505-792-2812
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Provider Business Mailing Address
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Address Line | 3309C JUAN TABO NEBLVD C
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-5130
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Country | US
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Telephone | 505-508-1654
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Fax | 505-508-2482
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD2007-0072
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License Number State | NM
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