MEDICARE: RICARDO NUNEZ CADC II

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	AII057330518	CA

General Provider Information

NPI Number	:	1699983627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICARDO NUNEZ CADC II

Provider Business Mailing Address
First Line	:	1081 CAMINO DEL RIO S STE 129
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3544
Country	:	US
Telephone Number	:	619-297-5131
Fax Number	:

Provider Business Practice Location Address
First Line	:	4161 MARLBOROUGH AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105
Country	:	US
Telephone Number	:	619-282-7274
Fax Number	:

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/16/2018

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