Provider Demographics
NPI:1215315130
Name:NUNGARAY, RAUL
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:NUNGARAY
Suffix:
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 1:1170 S FAIRFAX AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-4430
Mailing Address - Country:US
Mailing Address - Phone:323-984-0112
Mailing Address - Fax:
Practice Address - Street 1:1170 S FAIRFAX AVE APT 8
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-4430
Practice Address - Country:US
Practice Address - Phone:323-984-0112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst