1679665707 NPI number — ANTOINETTE MUNOZ PT

Table of content: ANTOINETTE MUNOZ PT (NPI 1679665707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679665707 NPI number — ANTOINETTE MUNOZ PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUNOZ
Provider First Name:
ANTOINETTE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679665707
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 776
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COTTONWOOD
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86326-0776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-639-0166
Provider Business Mailing Address Fax Number:
928-639-0167

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1835 W HIGHWAY 89A
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
SEDONA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86336-5570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-282-2411
Provider Business Practice Location Address Fax Number:
928-282-2067
Provider Enumeration Date:
09/28/2006

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: 225100000X , with the licence number:  4060 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 428179 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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