Provider Demographics
NPI:1689693509
Name:NUNEZ, LYDIA A (MD)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:A
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 1:1500 NW 12TH AVE STE 810
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1037
Mailing Address - Country:US
Mailing Address - Phone:305-585-6649
Mailing Address - Fax:305-585-5259
Practice Address - Street 1:3801 BISCAYNE BLVD STE 230
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-9800
Practice Address - Country:US
Practice Address - Phone:786-466-8490
Practice Address - Fax:305-573-6562
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68095207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH75228Medicare UPIN