Provider Demographics
NPI:1992216543
Name:NUNEZ RODRIGUEZ, CECILIA M (LPN)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:M
Last Name:NUNEZ RODRIGUEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CECILIA
Other - Middle Name:M
Other - Last Name:NUNEZ RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:12413 W FLANAGAN ST
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-3126
Mailing Address - Country:US
Mailing Address - Phone:480-352-9109
Mailing Address - Fax:
Practice Address - Street 1:3131 E CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4500
Practice Address - Country:US
Practice Address - Phone:602-508-1883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-22
Last Update Date:2017-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP050193164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse