Individual provider Active NPI

Leo Munoz

  • Psychologist
  • Peoria, AZ
National Provider Identifier
1407989916
Registry record updated Nov 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY-000300 Issued in AZ
Practice address
6739 W Cactus Rd
Peoria, AZ 85381-5311
Phone
(833) 242-0100
NPI assigned
Mar 13, 2007
Last updated
Nov 30, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PSY-000300 AZ Primary

Addresses

Primary practice location

6739 W Cactus Rd
Peoria, AZ 85381-5311

Mailing address

35578 N Goldrush LN
Queen Creek, AZ 85142-7805

Other identifiers 1

IdentifierTypeStateIssuer
118168MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190909003332 AZ Practitioner - Clinical Psychologist 4587993092 Reassigns benefits to 1 organization
Practice locations: Queen Creek, AZ

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1972
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

35578 N Goldrush LN
Queen Creek, AZ 85144-7805
Phone (480) 205-5866

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSY-000300AZMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Angels Valley Community Healthcare Center PLLC CurrentSince Aug 17, 2022 Accepting new patients

Locations

6739 W Cactus Rd
Peoria, AZ 85381
Phone (623) 240-1110

14820 N Cave Creek Rd
Ste 2
Phoenix, AZ 85032
Phone (202) 455-0013

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669766400000",
    "number": "1407989916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35578 N GOLDRUSH LN",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851427805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6739 W CACTUS RD",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853815311",
            "telephone_number": "833-242-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUNOZ",
        "first_name": "LEO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-13",
        "last_updated": "2022-11-30",
        "certification_date": "2022-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "AZ",
            "license": "PSY-000300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "118168",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, AZ

Sources for this page

Verify at the official NPI Registry.