Basic Information
| Provider Information | |||||||||
| NPI: | 1164035770 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MUNOZ CONSULTING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1684 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711651684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184245449 | ||||||||
| FaxNumber: | 8552301466 | ||||||||
| Practice Location | |||||||||
| Address1: | 4900 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | BOSSIER CITY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711124521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187479500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2020 | ||||||||
| LastUpdateDate: | 08/25/2020 | ||||||||
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| AuthorizedOfficialLastName: | MUNOZ | ||||||||
| AuthorizedOfficialFirstName: | DEREK | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4097286583 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.