Provider Demographics
NPI:1164692703
Name:NUNEZ, HERIBERTO (MD)
Entity Type:Individual
Prefix:
First Name:HERIBERTO
Middle Name:
Last Name:NUNEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 S ATLANTIC BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-6707
Mailing Address - Country:US
Mailing Address - Phone:626-284-3111
Mailing Address - Fax:626-872-2450
Practice Address - Street 1:850 S ATLANTIC BLVD STE 203
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-6707
Practice Address - Country:US
Practice Address - Phone:626-284-3111
Practice Address - Fax:626-872-2450
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79979207Q00000X, 207QA0505X, 207QG0300X, 207RG0300X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA79979OtherMEDICAL LICENSE