Provider Demographics
NPI:1215625991
Name:MUNOZ, RICARDO VIDAL (RN)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:VIDAL
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 S GLEBE RD APT 517
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-2548
Mailing Address - Country:US
Mailing Address - Phone:787-413-3286
Mailing Address - Fax:
Practice Address - Street 1:2400 S GLEBE RD APT 517
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-2548
Practice Address - Country:US
Practice Address - Phone:787-413-3286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001298614163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse