Provider Demographics
NPI:1063728053
Name:MUNOZ, BEAU (MD)
Entity type:Individual
Prefix:
First Name:BEAU
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25003 PEACHLAND AVE UNIT 112
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2525
Mailing Address - Country:US
Mailing Address - Phone:661-310-4629
Mailing Address - Fax:
Practice Address - Street 1:2005 KNIGHT LANE BLDG H ATTN: MEDICAL STAFF SERVICES
Practice Address - Street 2:MEDICINE SUPPORT COMMAND
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32212-0140
Practice Address - Country:US
Practice Address - Phone:619-532-8038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program