Healthcare Provider Details

I. General information

NPI: 1013839794
Provider Name (Legal Business Name): JUAN CARLOS NUNEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

570 GOLDEN EAGLE AVE
QUINCY CA
95971-9124
US

IV. Provider business mailing address

118 CLOUGH ST
QUINCY CA
95971-9698
US

V. Phone/Fax

Practice location:
  • Phone: 530-283-0202
  • Fax:
Mailing address:
  • Phone: 530-263-3616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: