Provider Demographics
NPI:1003038068
Name:MARIO L NUNEZ M D P A
Entity type:Organization
Organization Name:MARIO L NUNEZ M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MDPA
Authorized Official - Phone:305-898-1304
Mailing Address - Street 1:9075 SW 87TH AVE
Mailing Address - Street 2:SUITE#414
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2308
Mailing Address - Country:US
Mailing Address - Phone:305-596-9800
Mailing Address - Fax:305-596-9808
Practice Address - Street 1:9075 SW 87TH AVE
Practice Address - Street 2:SUITE#414
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2308
Practice Address - Country:US
Practice Address - Phone:305-596-9800
Practice Address - Fax:305-596-9808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0088619207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH97326Medicare UPIN
FLAE609Medicare PIN