Healthcare Provider Details

I. General information

NPI: 1609304344
Provider Name (Legal Business Name): GLORIA NATALIA NUNEZ MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 HUGHES WAY STE 150
LONG BEACH CA
90810-1878
US

IV. Provider business mailing address

1501 HUGHES WAY STE 150
LONG BEACH CA
90810-1878
US

V. Phone/Fax

Practice location:
  • Phone: 310-221-6336
  • Fax: 310-221-6350
Mailing address:
  • Phone: 310-221-6336
  • Fax: 310-221-6350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF83071
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number115885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: