Healthcare Provider Details

I. General information

NPI: 1790257517
Provider Name (Legal Business Name): LILIA M NUNEZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8627 ATLANTIC AVE
SOUTH GATE CA
90280-3501
US

IV. Provider business mailing address

PO BOX 3254
BELL GARDENS CA
90202-3254
US

V. Phone/Fax

Practice location:
  • Phone: 888-499-9303
  • Fax: 323-597-2184
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number103429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: