Provider Demographics
NPI:1649213638
Name:NUNEZ, LOURDES (MD)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20601 OLD CUTLER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-2441
Mailing Address - Country:US
Mailing Address - Phone:305-234-8321
Mailing Address - Fax:305-234-8358
Practice Address - Street 1:20601 OLD CUTLER RD STE 101
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-2441
Practice Address - Country:US
Practice Address - Phone:305-234-8321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60074207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055445600Medicaid
FL14227AMedicare ID - Type Unspecified
FL055445600Medicaid
FLAE331Medicare PIN