Provider Demographics
NPI:1104820075
Name:NUNEZ, GEORGINA
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 S LEMON AVE STE 6562
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2706
Mailing Address - Country:US
Mailing Address - Phone:213-218-6200
Mailing Address - Fax:
Practice Address - Street 1:441 W MACARTHUR BLVD APT 2
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2800
Practice Address - Country:US
Practice Address - Phone:213-218-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW144621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA753193428OtherUS BEHAVIORAL HEALTH
CA753193428OtherUNITED HEALTHCARE SERVICE