Provider Demographics
NPI:1780008938
Name:NUNEZ MCDONOUGH, PENNY
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:
Last Name:NUNEZ MCDONOUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:PENNY
Other - Middle Name:
Other - Last Name:NUNEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6550 S PECOS RD STE B-115
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-2828
Mailing Address - Country:US
Mailing Address - Phone:415-690-6635
Mailing Address - Fax:
Practice Address - Street 1:6550 S PECOS RD STE B-115
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-2828
Practice Address - Country:US
Practice Address - Phone:415-690-6635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-08
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 251B00000X, 3747P1801X, 374U00000X, 171M00000X
CA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1003305483Medicaid