Provider Demographics
NPI:1104964667
Name:NUNEZ, ELBA (MD)
Entity type:Individual
Prefix:DR
First Name:ELBA
Middle Name:
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELBA
Other - Middle Name:
Other - Last Name:GADEA DE NUNEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2925 10TH AVE N
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3000
Mailing Address - Country:US
Mailing Address - Phone:561-969-9252
Mailing Address - Fax:561-969-9257
Practice Address - Street 1:2925 10TH AVE N
Practice Address - Street 2:SUITE 106
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-3000
Practice Address - Country:US
Practice Address - Phone:561-969-9252
Practice Address - Fax:561-969-9257
Is Sole Proprietor?:No
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067667208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL240623OtherAMERIGROUP
FL000004205376OtherHEALTHY PALM BEACHES
FLSG07476F500OtherVISTA
FL26724OtherBLUECROSS AND BLUESHIELD
FLB15928Medicare UPIN
FLSG07476F500OtherVISTA