Healthcare Provider Details

I. General information

NPI: 1730346586
Provider Name (Legal Business Name): JOSE ANTONIO NUNEZ SA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8905 SW 87TH AVE
MIAMI FL
33176-2227
US

IV. Provider business mailing address

8905 SW 87TH AVE SUITE 100
MIAMI FL
33176-2227
US

V. Phone/Fax

Practice location:
  • Phone: 305-667-8686
  • Fax: 305-667-8680
Mailing address:
  • Phone: 305-667-8686
  • Fax: 305-667-8680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberCERT # 02-112
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: