Healthcare Provider Details

I. General information

NPI: 1164661617
Provider Name (Legal Business Name): MEMORY ANN NUNEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2531 W WOODLAND DR
ANAHEIM CA
92801-2637
US

IV. Provider business mailing address

2531 W WOODLAND DR
ANAHEIM CA
92801-2608
US

V. Phone/Fax

Practice location:
  • Phone: 714-226-9888
  • Fax: 714-226-9885
Mailing address:
  • Phone: 714-226-9888
  • Fax: 714-226-9885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number84865
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: