Provider Demographics
NPI:1871599209
Name:MUNOZ, MARIA CONCEPCION (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:CONCEPCION
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9420
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-9420
Mailing Address - Country:US
Mailing Address - Phone:787-798-1645
Mailing Address - Fax:787-798-1604
Practice Address - Street 1:1845 CARR 2
Practice Address - Street 2:STE 606
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7204
Practice Address - Country:US
Practice Address - Phone:787-798-1645
Practice Address - Fax:787-798-1604
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9921174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9921OtherSTATE LICENSE