Basic Information
| Provider Information | |||||||||
| NPI: | 1821762642 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MUNIZ RODRIGUEZ | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 640 | ||||||||
| Address2: | |||||||||
| City: | MOCA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006760640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078795297 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1530 CELEBRATION BLVD STE 407 | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347475165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3219394137 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2021 | ||||||||
| LastUpdateDate: | 10/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | ACN1375 | FL | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | 22511 | PR | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.