Provider Demographics
NPI:1720446925
Name:NUNEZ, MARIELLE BEATRIX M (RN)
Entity Type:Individual
Prefix:
First Name:MARIELLE BEATRIX
Middle Name:M
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX
Mailing Address - Street 2:2582
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91610-0601
Mailing Address - Country:US
Mailing Address - Phone:323-632-6487
Mailing Address - Fax:
Practice Address - Street 1:PO BOX
Practice Address - Street 2:2582
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91610-0601
Practice Address - Country:US
Practice Address - Phone:323-632-6487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95179435163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1720446925OtherCNS