Provider Demographics
NPI:1194970186
Name:DUREZA-MUNESES, RAQUEL CHRISTINE (MD)
Entity type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:CHRISTINE
Last Name:DUREZA-MUNESES
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 94
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-0094
Mailing Address - Country:US
Mailing Address - Phone:410-967-9370
Mailing Address - Fax:443-982-6055
Practice Address - Street 1:5339 N FRESNO ST
Practice Address - Street 2:SUITE 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6851
Practice Address - Country:US
Practice Address - Phone:559-375-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0068275207T00000X
CAG 84893207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH07224Medicare UPIN