Provider Demographics
NPI:1811424930
Name:NUNN, MAUREEN (MA ; CAADE 7622-R)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:
Last Name:NUNN
Suffix:
Gender:F
Credentials:MA ; CAADE 7622-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CREST RD W
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90274-5002
Mailing Address - Country:US
Mailing Address - Phone:310-544-3260
Mailing Address - Fax:310-541-8299
Practice Address - Street 1:235 W 9TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3711
Practice Address - Country:US
Practice Address - Phone:310-521-9209
Practice Address - Fax:310-521-9241
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-19
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7622-R171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator