Healthcare Provider Details

I. General information

NPI: 1669036661
Provider Name (Legal Business Name): RUBEN NUNEZ DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 7TH ST STE B
LAS VEGAS NM
87701-5177
US

IV. Provider business mailing address

1608 7TH ST STE B
LAS VEGAS NM
87701-5177
US

V. Phone/Fax

Practice location:
  • Phone: 610-628-8459
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC007024
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: