Healthcare Provider Details

I. General information

NPI: 1427646116
Provider Name (Legal Business Name): NELSON NUNEZ PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STATHAM BLVD
OXNARD CA
93033
US

IV. Provider business mailing address

1040 FLYNN RD
CAMARILLO CA
93012-8705
US

V. Phone/Fax

Practice location:
  • Phone: 805-920-7021
  • Fax: 805-728-1433
Mailing address:
  • Phone: 805-673-3930
  • Fax: 805-728-1433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19277
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberPA60737
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number60737
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60737
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: