Provider Demographics
NPI:1609433655
Name:NUNEZ, GLADYS R
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:R
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA GLADYS
Other - Middle Name:R
Other - Last Name:NUNEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RADT1-R1330141118
Mailing Address - Street 1:9505 MALECH DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-2002
Mailing Address - Country:US
Mailing Address - Phone:408-281-6572
Mailing Address - Fax:408-281-6564
Practice Address - Street 1:9505 MALECH DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95138-2002
Practice Address - Country:US
Practice Address - Phone:408-281-6572
Practice Address - Fax:408-281-6564
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARADT1-R1330141118101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)