Provider Demographics
NPI:1023178803
Name:NUNEZ, FERNANDO JOSE (CP)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:JOSE
Last Name:NUNEZ
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9102 FIRESTONE BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5348
Mailing Address - Country:US
Mailing Address - Phone:562-862-4711
Mailing Address - Fax:562-862-4711
Practice Address - Street 1:9102 FIRESTONE BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5348
Practice Address - Country:US
Practice Address - Phone:562-862-4711
Practice Address - Fax:562-862-4711
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1049610001Medicare NSC