Provider Demographics
NPI:1225753544
Name:NUNEZ, CRYSTAL ADILENE (MSAT STUDENT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ADILENE
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:MSAT STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 SUNSET WAY APT 8
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-1838
Mailing Address - Country:US
Mailing Address - Phone:805-550-0949
Mailing Address - Fax:
Practice Address - Street 1:3601 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95211-0110
Practice Address - Country:US
Practice Address - Phone:209-946-2588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program