Provider Demographics
NPI:1801351481
Name:NUNEZ, TANYA MONIQUE (PNP-PC)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:MONIQUE
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:PNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14752 BLUE SKY RD
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-4305
Mailing Address - Country:US
Mailing Address - Phone:626-677-7058
Mailing Address - Fax:
Practice Address - Street 1:14752 BLUE SKY RD
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-4305
Practice Address - Country:US
Practice Address - Phone:626-677-7058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009126363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics