Healthcare Provider Details

I. General information

NPI: 1083151641
Provider Name (Legal Business Name): MRS. MARIAN DE LOURDES NUNEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 CALLE PERSEO 87 URB LOMAS DEL SOL
GURABO PR
00778
US

IV. Provider business mailing address

87 URB LOMAS DEL SOL
GURABO PR
00778
US

V. Phone/Fax

Practice location:
  • Phone: 787-384-2656
  • Fax:
Mailing address:
  • Phone: 787-384-2656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number15809
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number15809
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: