MEDICARE: MS. ELISA MUNOZ NURSE PRACTITIONER

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	163WW0101X	Ambulatory Women's Health Care Registered Nurse	C278641	CA

General Provider Information

NPI Number	:	1801046628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELISA MUNOZ NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	1230 W 3RD ST FL 4
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-1408
Country	:	US
Telephone Number	:	213-481-2511
Fax Number	:

Provider Business Practice Location Address
First Line	:	1230 W 3RD ST FL 4
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-1408
Country	:	US
Telephone Number	:	213-481-2511
Fax Number	:

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

Provider Enumeration Date	:	09/29/2008
Last Update Date	:	09/29/2008

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