Provider Demographics
NPI:1386957025
Name:MUNOZ, JUAN (IDC)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8857 1ST ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23511-3713
Mailing Address - Country:US
Mailing Address - Phone:757-445-6103
Mailing Address - Fax:
Practice Address - Street 1:8857 1ST ST
Practice Address - Street 2:SUITE 400
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511-3713
Practice Address - Country:US
Practice Address - Phone:757-445-6103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman