Provider Demographics
NPI:1871046920
Name:NUNEZ, JOAQUIN
Entity Type:Individual
Prefix:
First Name:JOAQUIN
Middle Name:
Last Name:NUNEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21890 W. COLORADO AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN JOAQUIN
Mailing Address - State:CA
Mailing Address - Zip Code:93660
Mailing Address - Country:US
Mailing Address - Phone:559-456-5560
Mailing Address - Fax:
Practice Address - Street 1:21890 W. COLORADO AVE.
Practice Address - Street 2:
Practice Address - City:SAN JOAQUIN
Practice Address - State:CA
Practice Address - Zip Code:93660-2010
Practice Address - Country:US
Practice Address - Phone:559-456-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program