MEDICARE: PAOLA DAZA NUNEZ MD

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	208000000X	Pediatrics Physician	MD484631	PA

General Provider Information

NPI Number	:	1457820805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAOLA DAZA NUNEZ MD

Provider Business Mailing Address
First Line	:	401 W ALLEGHENY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-3647
Country	:	US
Telephone Number	:	215-291-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 W ALLEGHENY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-3647
Country	:	US
Telephone Number	:	215-291-2500
Fax Number	:

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

Provider Enumeration Date	:	11/15/2018
Last Update Date	:	03/22/2026

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