Healthcare Provider Details

I. General information

NPI: 1104964667
Provider Name (Legal Business Name): ELBA NUNEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELBA GADEA DE NUNEZ MD

II. Dates (important events)

Enumeration Date: 02/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 10TH AVE N SUITE 106
LAKE WORTH FL
33461-3000
US

IV. Provider business mailing address

2925 10TH AVE N SUITE 106
LAKE WORTH FL
33461-3000
US

V. Phone/Fax

Practice location:
  • Phone: 561-969-9252
  • Fax: 561-969-9257
Mailing address:
  • Phone: 561-969-9252
  • Fax: 561-969-9257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0067667
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: