Provider Demographics
NPI:1366138513
Name:MUNOZ, GENEVIEVE COLLETTE (MD)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:COLLETTE
Last Name:MUNOZ
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 1:757 WESTWOOD PLZ STE 1638
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-7437
Mailing Address - Country:US
Mailing Address - Phone:310-267-8797
Mailing Address - Fax:310-267-2059
Practice Address - Street 1:757 WESTWOOD PLZ STE 1638
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-7437
Practice Address - Country:US
Practice Address - Phone:310-267-8797
Practice Address - Fax:310-267-2059
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230237482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty