Healthcare Provider Details

I. General information

NPI: 1689012817
Provider Name (Legal Business Name): BETHANY NUNEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 MARSHA SHARP FWY
LUBBOCK TX
79407-2520
US

IV. Provider business mailing address

2215 NASHVILLE AVE
LUBBOCK TX
79410-1105
US

V. Phone/Fax

Practice location:
  • Phone: 806-725-1002
  • Fax: 806-542-5607
Mailing address:
  • Phone: 806-725-5228
  • Fax: 806-723-6532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberQ8385
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: