Healthcare Provider Details

I. General information

NPI: 1518882612
Provider Name (Legal Business Name): HEIDI ELAINE NUNES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1581 CUMMINS DR STE C
MODESTO CA
95358-6402
US

IV. Provider business mailing address

1581 CUMMINS DR STE C
MODESTO CA
95358-6402
US

V. Phone/Fax

Practice location:
  • Phone: 209-492-5113
  • Fax: 209-574-1541
Mailing address:
  • Phone: 209-492-5113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number51DDFD4783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: