Provider Demographics
NPI:1891947768
Name:HERIBERTO NUNEZ MD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:HERIBERTO NUNEZ MD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:HERIBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-284-3111
Mailing Address - Street 1:850 S ATLANTIC BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-6707
Mailing Address - Country:US
Mailing Address - Phone:626-284-3111
Mailing Address - Fax:626-872-2450
Practice Address - Street 1:850 S ATLANTIC BLVD STE 203
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-6707
Practice Address - Country:US
Practice Address - Phone:626-284-3111
Practice Address - Fax:626-872-2450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1891947768Medicaid
CA1891947768OtherHMO