Provider Demographics
NPI:1376732701
Name:NUNEZ, LUIS AGRAVANTE (IDC)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:AGRAVANTE
Last Name:NUNEZ
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:US NAVAL HOSPITAL YOKOSUKA
Mailing Address - Street 2:PSC 475 BOX 1413
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96350
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:US NAVAL HOSPITAL YOKOSUKA
Practice Address - Street 2:PSC 475 BOX 1413
Practice Address - City:FPO AP
Practice Address - State:JAPAN
Practice Address - Zip Code:96350
Practice Address - Country:JP
Practice Address - Phone:0118146-896-3423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman