Healthcare Provider Details

I. General information

NPI: 1275158610
Provider Name (Legal Business Name): HECTOR NUNEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 5TA EMILIANO ZAPATA #7617-2, ZONA CENTRO
TIJUANA BAJA CALIFORINA
22000
MX

IV. Provider business mailing address

511 E SAN YSIDRO BLVD. #7630
SAN YSIDRO CA
92173
US

V. Phone/Fax

Practice location:
  • Phone: 619-272-3080
  • Fax: 858-430-3143
Mailing address:
  • Phone: 619-272-3080
  • Fax: 858-430-3143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. HECTOR NUNEZ
Title or Position: OWNER
Credential: DDS
Phone: 619-272-3080