1740421247 NPI number — GYSELLA BEGONIA MUNIZ PUJALT MD

Table of content: GYSELLA BEGONIA MUNIZ PUJALT MD (NPI 1740421247)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740421247 NPI number — GYSELLA BEGONIA MUNIZ PUJALT MD

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
MUNIZ PUJALT

Provider First Name:
GYSELLA

Provider Middle Name:
BEGONIA

Provider Name Prefix Text:

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:

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:
1740421247

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
01/15/2013

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7228 SWANSONG WAY

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
BETHESDA

Provider Business Mailing Address State Name:
MD

Provider Business Mailing Address Postal Code:
20817-1271

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
301-801-5985

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3800 RESERVOIR RD NW

Provider Second Line Business Practice Location Address:
2ND FLOOR PHC

Provider Business Practice Location Address City Name:
WASHINGTON

Provider Business Practice Location Address State Name:
DC

Provider Business Practice Location Address Postal Code:
20007-2113

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
202-444-8882

Provider Business Practice Location Address Fax Number:
202-444-2961

Provider Enumeration Date:
03/12/2009

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Taxonomy code: 208000000X , with the licence number: D0073670 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .