MEDICARE: MR. MIGUEL MUNOZ HERNANDEZ

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1245424837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MIGUEL MUNOZ HERNANDEZ

Provider Business Mailing Address
First Line	:	1301 S ESPINA ST
Second Line	:	APT 13
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3797
Country	:	US
Telephone Number	:	505-805-3193
Fax Number	:	505-882-1879

Provider Business Practice Location Address
First Line	:	1301 S ESPINA ST
Second Line	:	APT 13
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3797
Country	:	US
Telephone Number	:	505-805-3193
Fax Number	:	505-882-1879

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

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	08/28/2007

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