Healthcare Provider Details

I. General information

NPI: 1811121197
Provider Name (Legal Business Name): KAREN ROSA NUNEZ-WALLACE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19066 MAGNOLIA ST
HUNTINGTON BEACH CA
92646-2232
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 714-968-0068
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberBP10034902
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberC163965
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: