Provider Demographics
NPI:1568741999
Name:NUNEZ, JONATHAN
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:NUNEZ
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 1:310 E MAIN AVE
Mailing Address - Street 2:PMB #149
Mailing Address - City:ALTON
Mailing Address - State:TX
Mailing Address - Zip Code:78573-6872
Mailing Address - Country:US
Mailing Address - Phone:956-212-7927
Mailing Address - Fax:956-583-9225
Practice Address - Street 1:2704 W 65TH ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-5410
Practice Address - Country:US
Practice Address - Phone:956-212-7927
Practice Address - Fax:956-583-9225
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications