Provider Demographics
NPI:1104465665
Name:NUNEZ, PETE MIGUEL JR
Entity type:Individual
Prefix:
First Name:PETE
Middle Name:MIGUEL
Last Name:NUNEZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W 6TH ST BLDG B113
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85721-0300
Mailing Address - Country:US
Mailing Address - Phone:520-621-0450
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:220 W 6TH ST BLDG B113
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-0300
Practice Address - Country:US
Practice Address - Phone:520-621-0450
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
AZT035826183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No174H00000XOther Service ProvidersHealth Educator