=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780980276
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARLOS NUNEZ LMT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2011
-----------------------------------------------------
Last Update Date | 02/01/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13208 SW 8TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33184-1176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-222-9992
-----------------------------------------------------
Fax | 305-222-9994
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13208 SW 8TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33184-1176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-222-9992
-----------------------------------------------------
Fax | 305-222-9994
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | HCC8903
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------