=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659706935
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUAN EDUARDO MUNOZ OCA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2013
-----------------------------------------------------
Last Update Date | 08/05/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12607 SE MILL PLAIN BLVD CASCADE PARK MEDICAL OFFICE FAMILY MEDICINE
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98684-4098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-418-6001
-----------------------------------------------------
Fax | 360-896-4472
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12607 SE MILL PLAIN BLVD CASCADE PARK MEDICAL OFFICE FAMILY MEDICINE
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98684-4098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-418-6001
-----------------------------------------------------
Fax | 360-896-4472
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 60654646
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 18578
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------