MEDICARE: MR. JOSE M. MUNIZ III

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	101YM0800X	Mental Health Counselor		OK

General Provider Information

NPI Number	:	1326753070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSE M. MUNIZ III

Provider Business Mailing Address
First Line	:	3409 SHUTTER RIDGE DR
Second Line	:
City	:	YUKON
State	:	OK
Zip	:	73099-7366
Country	:	US
Telephone Number	:	650-740-2401
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 NW 63RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1921
Country	:	US
Telephone Number	:	405-555-5555
Fax Number	:

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

Provider Enumeration Date	:	01/17/2023
Last Update Date	:	12/15/2025

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