1457465999 NPI number — DR. ANGELICA CARRANZA MUNGER MD

Table of content: DR. ANGELICA CARRANZA MUNGER MD (NPI 1457465999)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457465999 NPI number — DR. ANGELICA CARRANZA MUNGER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUNGER
Provider First Name:
ANGELICA
Provider Middle Name:
CARRANZA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARRANZA
Provider Other First Name:
ANGELICA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457465999
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8010 S COUNTY ROAD 5
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
WINDSOR
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80528-9002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-377-1300
Provider Business Mailing Address Fax Number:
970-377-1314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8010 S COUNTY ROAD 5
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
WINDSOR
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80528-9002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-377-1300
Provider Business Practice Location Address Fax Number:
970-377-1314
Provider Enumeration Date:
08/19/2006

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: 225400000X , with the licence number:  40122 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2083X0100X , with the licence number: 40122 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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