Provider Demographics
NPI:1528165271
Name:MUNOZ, ANDREA LYNN (PAC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNN
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 VIA DE LA VALLE
Mailing Address - Street 2:STE 200
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-1992
Mailing Address - Country:US
Mailing Address - Phone:858-309-3116
Mailing Address - Fax:858-309-3139
Practice Address - Street 1:2600 VIA DE LA VALLE
Practice Address - Street 2:STE 200
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-1992
Practice Address - Country:US
Practice Address - Phone:858-309-3116
Practice Address - Fax:858-309-3139
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17566363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330454950OtherGROUP ID#