Healthcare Provider Details

I. General information

NPI: 1659693570
Provider Name (Legal Business Name): GRACIELA V NUNEZ M.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SANTOS DEGOLLADO 2229 COL. GUERRERO
NUEVO LAREDO TAMAULIPAS
88240
MX

IV. Provider business mailing address

413 JORDAN DR
LAREDO TX
78041-9126
US

V. Phone/Fax

Practice location:
  • Phone: 867-715-1405
  • Fax:
Mailing address:
  • Phone: 956-242-4144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1150654
License Number StateZZ
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3624692
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: