Provider Demographics
NPI:1053149989
Name:MUNOZ, VICTOR ANDRES
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:ANDRES
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 VAUGHN ST APT 9
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-3964
Mailing Address - Country:US
Mailing Address - Phone:305-337-7721
Mailing Address - Fax:
Practice Address - Street 1:1032 VAUGHN ST APT 9
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-3964
Practice Address - Country:US
Practice Address - Phone:305-337-7721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
993648340OtherBCBS