Provider Demographics
NPI:1821441114
Name:NUNEZ, NOEL (AGACNP-BC)
Entity Type:Individual
Prefix:MR
First Name:NOEL
Middle Name:
Last Name:NUNEZ
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16350 VENTURA BLVD UNIT 309
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-5307
Mailing Address - Country:US
Mailing Address - Phone:747-998-5462
Mailing Address - Fax:
Practice Address - Street 1:16350 VENTURA BLVD UNIT 309
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-5307
Practice Address - Country:US
Practice Address - Phone:747-998-5462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004537363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95004537OtherSTATE BOARD OF CALIFORNIA