Healthcare Provider Details

I. General information

NPI: 1275451130
Provider Name (Legal Business Name): ROBERT NUNEZ
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12180 BROOKHURST ST
GARDEN GROVE CA
92840-2817
US

IV. Provider business mailing address

9808 CHAPMAN AVE
GARDEN GROVE CA
92841-2711
US

V. Phone/Fax

Practice location:
  • Phone: 714-643-5501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number1231523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: