Provider Demographics
NPI:1164625067
Name:LOURDES NUNEZ MD PA
Entity Type:Organization
Organization Name:LOURDES NUNEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREM
Authorized Official - Middle Name:
Authorized Official - Last Name:TORIBIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-234-8321
Mailing Address - Street 1:12002 SW 128TH CT
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4639
Mailing Address - Country:US
Mailing Address - Phone:305-234-8321
Mailing Address - Fax:305-234-8358
Practice Address - Street 1:12002 SW 128TH CT
Practice Address - Street 2:SUITE 210
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4639
Practice Address - Country:US
Practice Address - Phone:305-234-8321
Practice Address - Fax:305-234-8358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60074208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055445600Medicaid
FLF06645Medicare UPIN
FL055445600Medicaid