1407144884 NPI number — MRS. ROSELIE L. MUNOZ M.A.

Table of content: MRS. ROSELIE L. MUNOZ M.A. (NPI 1407144884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407144884 NPI number — MRS. ROSELIE L. MUNOZ M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUNOZ
Provider First Name:
ROSELIE
Provider Middle Name:
L.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEDINA
Provider Other First Name:
ROSELIE
Provider Other Middle Name:
L.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407144884
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
385 CALLE DE ALEGRA STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88005-3423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-526-1105
Provider Business Mailing Address Fax Number:
575-524-4266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
880 ANTHONY DR
Provider Second Line Business Practice Location Address:
SUITE 12
Provider Business Practice Location Address City Name:
ANTHONY
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88021-9346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-201-5134
Provider Business Practice Location Address Fax Number:
575-201-5108
Provider Enumeration Date:
07/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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