Provider Demographics
NPI:1578371639
Name:MACIEL MUNOZ, MELIZA BRIDGET
Entity type:Individual
Prefix:
First Name:MELIZA
Middle Name:BRIDGET
Last Name:MACIEL MUNOZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6984 MOHAWK ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-1744
Mailing Address - Country:US
Mailing Address - Phone:619-891-6385
Mailing Address - Fax:
Practice Address - Street 1:6984 MOHAWK ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-1744
Practice Address - Country:US
Practice Address - Phone:619-891-6385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-20
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374700402372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty