1811158900 NPI number — DR. DIANA MARIE MUNOZ DO, MA, MPH

Table of content: DR. DIANA MARIE MUNOZ DO, MA, MPH (NPI 1811158900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811158900 NPI number — DR. DIANA MARIE MUNOZ DO, MA, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUNOZ
Provider First Name:
DIANA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO, MA, MPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MUNOZ
Provider Other First Name:
DIANA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO, MA, MPH
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1811158900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1805 E. DYER ROAD
Provider Second Line Business Mailing Address:
#110
Provider Business Mailing Address City Name:
SANTA ANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92705-5742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-955-0022
Provider Business Mailing Address Fax Number:
949-743-0567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1805 E. DYER ROAD
Provider Second Line Business Practice Location Address:
#110
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92705-5742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-955-0022
Provider Business Practice Location Address Fax Number:
949-743-0567
Provider Enumeration Date:
06/20/2008

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: 208100000X , with the licence number:  20A10370 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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