MEDICARE: AUBREY MUNOZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1164099859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUBREY MUNOZ

Provider Business Mailing Address
First Line	:	118 MARBLERIDGE RD
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-2962
Country	:	US
Telephone Number	:	540-229-3159
Fax Number	:

Provider Business Practice Location Address
First Line	:	280 CHARLES H DIMMOCK PKWY STE 2
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2940
Country	:	US
Telephone Number	:	540-229-3159
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2021
Last Update Date	:	11/15/2022

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