MEDICARE: MR. JORGE 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	172A00000X	Driver

General Provider Information

NPI Number	:	1598232233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JORGE MUNOZ

Provider Business Mailing Address
First Line	:	5214 NW WEST PIPER CIR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34986-2771
Country	:	US
Telephone Number	:	786-372-3836
Fax Number	:

Provider Business Practice Location Address
First Line	:	5214 NW WEST PIPER CIR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34986-2771
Country	:	US
Telephone Number	:	786-372-3836
Fax Number	:

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

Provider Enumeration Date	:	10/31/2018
Last Update Date	:	10/31/2018

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Directions to “ MR. JORGE MUNOZ ” Practice Location

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