Healthcare Provider Details

I. General information

NPI: 1518211945
Provider Name (Legal Business Name): NUCONCEPT CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10550 NW 77TH CT SUITE 312
HIALEAH FL
33016-7084
US

IV. Provider business mailing address

10550 NW 77TH CT SUITE 312
HIALEAH FL
33016-7084
US

V. Phone/Fax

Practice location:
  • Phone: 305-821-0554
  • Fax: 305-675-2668
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RUBEN J NUNEZ
Title or Position: OWNER
Credential: MD
Phone: 305-821-0554