Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 4301 | PR |
Y | 103T00000X | Psychologist | 4301 | PR |
NPI | 1003161670 |
---|---|
Provider Name | Mr. Jonathan Muniz |
First Address | Rincon, PR 00677-2606 |
Second Address | Anasco, PR 00610-2603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2012 |
Last Update Date | 19/07/2012 |