Healthcare Provider Details

I. General information

NPI: 1194491894
Provider Name (Legal Business Name): KIMBERLY NUNEZ BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2021
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6116 MEDAU PL
OAKLAND CA
94611-2809
US

IV. Provider business mailing address

1453 7TH AVE APT 2
SAN FRANCISCO CA
94122-3734
US

V. Phone/Fax

Practice location:
  • Phone: 510-339-2116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number55004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: