Provider Demographics
NPI:1215628318
Name:MUNGUIA, MARIE LOUISE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:LOUISE
Last Name:MUNGUIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10150 SW 143RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6987
Mailing Address - Country:US
Mailing Address - Phone:786-381-3806
Mailing Address - Fax:
Practice Address - Street 1:10150 SW 143RD PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6987
Practice Address - Country:US
Practice Address - Phone:786-381-3806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician