Provider Demographics
NPI:1811375629
Name:NUNEZ, BLANCA ESTELA (PA)
Entity Type:Individual
Prefix:MS
First Name:BLANCA
Middle Name:ESTELA
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-5720
Mailing Address - Fax:
Practice Address - Street 1:1520 SAN PABLO ST STE 3800
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5328
Practice Address - Country:US
Practice Address - Phone:323-442-5720
Practice Address - Fax:760-489-7638
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA52431363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical