Healthcare Provider Details

I. General information

NPI: 1134860232
Provider Name (Legal Business Name): JASON NUNEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST CLINIC TOWER, SUITE A7D
LOS ANGELES CA
90033-1029
US

IV. Provider business mailing address

PO BOX 433786
SAN DIEGO CA
92143-3786
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-6614
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA190046
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: