Healthcare Provider Details

I. General information

NPI: 1235288028
Provider Name (Legal Business Name): MRS. LUPE NUNO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9134 ENFIELD WAY
EL PASO TX
79907-4708
US

IV. Provider business mailing address

9134 ENFIELD WAY
EL PASO TX
79907-4708
US

V. Phone/Fax

Practice location:
  • Phone: 915-853-1566
  • Fax:
Mailing address:
  • Phone: 915-859-1566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: