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General NPI Number Information
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NPI Number | 1811769995
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Entity Type | Individual
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Provider Name | STEPHANIE MARIE NUNEZ-RIVERA ACSW, MPA
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Gender | Female
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Dates
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Enumeration Date | 10/23/2023
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Last Update Date | 01/26/2024
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Provider Practice Location Address
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Address Line | 1370 S STATE ST
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City | SAN JACINTO
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State | CA
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Zip | 92583-4933
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Country | US
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Telephone | 951-791-2715
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Fax |
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Provider Business Mailing Address
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Address Line | 2007 OPAL ST
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City | BANNING
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State | CA
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Zip | 92220-1014
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Country | US
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Telephone | 909-705-7849
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 116588
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License Number State | CA
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