Provider Demographics
NPI:1457391286
Name:MARIETTA-NUNEZ, DEBORAH (DO)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:MARIETTA-NUNEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 MAYFAIR DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-3524
Mailing Address - Country:US
Mailing Address - Phone:248-886-1641
Mailing Address - Fax:
Practice Address - Street 1:6900 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1168
Practice Address - Country:US
Practice Address - Phone:586-756-7777
Practice Address - Fax:586-756-7788
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012923207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H10774Medicare UPIN
MIP13590003Medicare ID - Type Unspecified