Provider Demographics
NPI:1932129855
Name:MIGUEL A NUNEZ JR MD PA
Entity Type:Organization
Organization Name:MIGUEL A NUNEZ JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-442-0633
Mailing Address - Street 1:2645 SW 37TH AVE
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2754
Mailing Address - Country:US
Mailing Address - Phone:305-442-0633
Mailing Address - Fax:305-442-9537
Practice Address - Street 1:2645 SW 37TH AVE
Practice Address - Street 2:6TH FLOOR
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2754
Practice Address - Country:US
Practice Address - Phone:305-442-0633
Practice Address - Fax:305-442-9537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063184261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371947200Medicaid
FL18432Medicare PIN
FLF48911Medicare UPIN