Healthcare Provider Details

I. General information

NPI: 1053925321
Provider Name (Legal Business Name): MIRANDA NUNEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 E FRONT AVE
SPOKANE WA
99202-2139
US

IV. Provider business mailing address

605 S COOLIDGE ST
MOSES LAKE WA
98837-1873
US

V. Phone/Fax

Practice location:
  • Phone: 509-626-9900
  • Fax:
Mailing address:
  • Phone: 509-764-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61631941
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRTL22-0109
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: