Provider Demographics
NPI:1073615944
Name:MUNIZ, GERARDO (PA)
Entity type:Individual
Prefix:
First Name:GERARDO
Middle Name:
Last Name:MUNIZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 SEQUOIA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:CA
Mailing Address - Zip Code:93247-1422
Mailing Address - Country:US
Mailing Address - Phone:559-562-9399
Mailing Address - Fax:559-562-4248
Practice Address - Street 1:755 SEQUOIA AVE STE B
Practice Address - Street 2:
Practice Address - City:LINDSAY
Practice Address - State:CA
Practice Address - Zip Code:93247-1422
Practice Address - Country:US
Practice Address - Phone:559-562-9399
Practice Address - Fax:559-562-4248
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18139363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA18139OtherLICENSE
CACC321Medicare PIN
CAPA18139OtherLICENSE