Healthcare Provider Details

I. General information

NPI: 1265317200
Provider Name (Legal Business Name): ANDREA NUNEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 BONAVENTURE BLVD STE 2020
WESTON FL
33326-4041
US

IV. Provider business mailing address

820 S PARK RD APT 315
HOLLYWOOD FL
33021-8717
US

V. Phone/Fax

Practice location:
  • Phone: 954-656-3603
  • Fax:
Mailing address:
  • Phone: 915-791-2238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-431259
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: