Healthcare Provider Details

I. General information

NPI: 1558050864
Provider Name (Legal Business Name): JAZMINE NUNEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W TOWN AND COUNTRY RD STE 1225
ORANGE CA
92868-4638
US

IV. Provider business mailing address

310 N EMILY ST
ANAHEIM CA
92805-3026
US

V. Phone/Fax

Practice location:
  • Phone: 840-260-0857
  • Fax:
Mailing address:
  • Phone: 714-852-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: