Healthcare Provider Details

I. General information

NPI: 1639965577
Provider Name (Legal Business Name): LAZARO NUNEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 HARRISON ST APT 1404
SAN FRANCISCO CA
94103-4465
US

IV. Provider business mailing address

1222 HARRISON ST APT 1404
SAN FRANCISCO CA
94103-4465
US

V. Phone/Fax

Practice location:
  • Phone: 305-942-7139
  • Fax:
Mailing address:
  • Phone: 305-942-7139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License NumberRHT00108322
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License NumberRHN00004320
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: