Healthcare Provider Details

I. General information

NPI: 1356829972
Provider Name (Legal Business Name): TANIA Y NUNEZ PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12555 LAKEWOOD BLVD
DOWNEY CA
90242-2771
US

IV. Provider business mailing address

21607 JUAN AVE APT 11
HAWAIIAN GARDENS CA
90716-1145
US

V. Phone/Fax

Practice location:
  • Phone: 562-923-4704
  • Fax:
Mailing address:
  • Phone: 562-405-1068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA49309
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: