Healthcare Provider Details

I. General information

NPI: 1396047437
Provider Name (Legal Business Name): DAVID LAWRENCE NUNEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2010
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W 17TH ST SUITE 101M
SANTA ANA CA
92706-2316
US

IV. Provider business mailing address

1725 W 17TH ST SUITE 101M
SANTA ANA CA
92706-2316
US

V. Phone/Fax

Practice location:
  • Phone: 714-567-6253
  • Fax: 714-834-8370
Mailing address:
  • Phone: 714-567-6253
  • Fax: 714-834-8370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG69151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: