MEDICARE: LUCIA 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	106S00000X	Behavior Technician	RBT-17-44658

General Provider Information

NPI Number	:	1205343993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCIA NUNEZ

Provider Business Mailing Address
First Line	:	2910 CREEK TREE LN
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-6324
Country	:	US
Telephone Number	:	678-595-7384
Fax Number	:

Provider Business Practice Location Address
First Line	:	429 CREEKSTONE RDG
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-3746
Country	:	US
Telephone Number	:	678-996-4998
Fax Number	:

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

Provider Enumeration Date	:	01/04/2018
Last Update Date	:	01/04/2018

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Directions to “ LUCIA NUNEZ ” Practice Location

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