Healthcare Provider Details

I. General information

NPI: 1639639636
Provider Name (Legal Business Name): KASSANDRA NUNEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 E MCDOWELL RD STE 134
PHOENIX AZ
85006-2521
US

IV. Provider business mailing address

4001 N CENTRAL AVE APT 242
PHOENIX AZ
85012-2140
US

V. Phone/Fax

Practice location:
  • Phone: 602-288-0777
  • Fax:
Mailing address:
  • Phone: 201-835-8788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7963
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: