MEDICARE: MR. JORGE LUIS NUNEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	126800000X	Dental Assistant	4480889	CA

General Provider Information

NPI Number	:	1043446933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JORGE LUIS NUNEZ

Provider Business Mailing Address
First Line	:	5048 LONG BEACH AVE #460
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90058
Country	:	US
Telephone Number	:	323-585-8940
Fax Number	:

Provider Business Practice Location Address
First Line	:	5048 LONG BEACH AVE #460
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90058
Country	:	US
Telephone Number	:	323-585-8940
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2009
Last Update Date	:	06/05/2009

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