Provider Demographics
NPI:1194732859
Name:NUNEZ, J DANEIEL (CP)
Entity type:Individual
Prefix:MR
First Name:J
Middle Name:DANEIEL
Last Name:NUNEZ
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1106 E 17TH STREET
Mailing Address - Street 2:STE D
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2603
Mailing Address - Country:US
Mailing Address - Phone:714-547-6106
Mailing Address - Fax:714-550-7443
Practice Address - Street 1:1106 E 17TH STREET
Practice Address - Street 2:STE D
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2603
Practice Address - Country:US
Practice Address - Phone:714-547-6106
Practice Address - Fax:714-550-7443
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0498390001Medicaid