Provider Demographics
NPI:1376668673
Name:NUNEZ, JAMES ANTHONY (RDO)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ANTHONY
Last Name:NUNEZ
Suffix:
Gender:M
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-4800
Mailing Address - Country:US
Mailing Address - Phone:909-875-1527
Mailing Address - Fax:909-875-3589
Practice Address - Street 1:570 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-4800
Practice Address - Country:US
Practice Address - Phone:909-875-1527
Practice Address - Fax:909-875-3589
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADX006360F156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADX006360FMedicaid