MEDICARE: MRS. BRISEIDA MUNOZ MD

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	2080H0002X	Pediatric Hospice and Palliative Medicine Physician	8076	PR
2	208000000X	Pediatrics Physician	ACN1250	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	29746MU	OTHER	PR	SSS

General Provider Information

NPI Number	:	1174643308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRISEIDA MUNOZ MD

Provider Business Mailing Address
First Line	:	4425 LAKE CALABAY DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-5468
Country	:	US
Telephone Number	:	787-646-8926
Fax Number	:

Provider Business Practice Location Address
First Line	:	1117 S SEMORAN BLVD STE B
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-1480
Country	:	US
Telephone Number	:	407-930-1114
Fax Number	:

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/10/2023

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