Provider Demographics
NPI:1467123901
Name:ZUNIGA, GARY EDWIN
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:EDWIN
Last Name:ZUNIGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 W WOOD HILL DR
Mailing Address - Street 2:
Mailing Address - City:NAGS HEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27959-9394
Mailing Address - Country:US
Mailing Address - Phone:252-441-0300
Mailing Address - Fax:252-441-3042
Practice Address - Street 1:114 W WOOD HILL DR
Practice Address - Street 2:
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-9394
Practice Address - Country:US
Practice Address - Phone:252-441-0300
Practice Address - Fax:252-441-3042
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman