Provider Demographics
NPI:1962879114
Name:MUNIZ, PATRICK (US NAVY IDC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:MUNIZ
Suffix:
Gender:M
Credentials:US NAVY IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10638 OUTPOST DR.
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410
Mailing Address - Country:US
Mailing Address - Phone:757-469-1705
Mailing Address - Fax:
Practice Address - Street 1:34101 FARENHOLT AVENUE
Practice Address - Street 2:BUILDING 14
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134
Practice Address - Country:US
Practice Address - Phone:619-532-7968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA146M00000X, 247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAUS NAVYOtherUS NAVY, SURFACE WARFARE MEDICAL INSTITUTE